Creighton University/St. Joseph's Medical Center Phoenix, AZ, United States
Zaid Ansari, MD1, Shehroz Aslam, MD2, Jacob Moussa, MD2, Mustafa Alani, MD3, Andrew M. Weinberg, DO4, Indu Srinivasan, MD5, Keng-Yu Chuang, MD1 1Creighton University School of Medicine Phoenix Program, Phoenix, AZ; 2Creighton University, Dignity Health St. Joseph's Medical Center, Phoenix, AZ; 3Creighton University/St. Joseph's Medical Center, Phoenix, AZ; 4St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Valleywise Health, Peoria, AZ; 5Creighton University/Valleywise Health, Phoenix, AZ
Introduction: The arteria lusoria is an aberrant right subclavian artery that passes dorsally between the esophagus and the spine. This artery arises from the aortic arch distal to the left subclavian artery. Normally this anomaly causes no symptoms. Dysphagia lusoria (DL) is the term coined to describe the dysphagia caused by such an extrinsic compression.
Case Description/Methods: The patient is a 26-year-old female who presented to the clinic after a recent ER visit for chest pain. She reported a two-day history of right-sided chest pain that is worse on inspiration, radiates to her shoulder blades, and was associated with dysphagia as well as globus sensation. Her dysphagia was worse with solids than liquids. She did not have a history of GERD, thyroid abnormalities, smoking, or alcohol use. Her physical exam and labs were unremarkable. EKG and Chest x-ray were also normal. An esophagram and CT chest and abdomen were ordered. During the barium swallow, a narrowing at the level of the clavicles due to extrinsic compression was appreciated. There was delayed passage of a 13mm barium tablet during the study and the patient expressed significant discomfort. Comparison with CT demonstrated an aberrant right subclavian artery coursing posterior to the esophagus. The diagnosis of DL was established and the patient was referred to vascular surgery for evaluation and management.
Discussion: DL is a congenital aortic arch anomaly (prevalence 0.16-4.4%). Barium esophagram shows a characteristic diagonal impression at the level of the fourth thoracic vertebra. EGD frequently reveals a diagonal pulsating impression on the posterior esophageal wall. Manometry is nonspecific but may exhibit high peristalsis pressure above the level of impression. Dietary modification to soft foods and a combination of a PPI and a motility agent have shown to be effective but raises the question of whether the pathophysiology of DL is simply mechanical. Multiple surgical techniques, including ligation of the aberrant artery at the origin and translocation to the right carotid, have achieved success for patients who failed medical therapy. Esophageal dilation may serve as a temporizing measure for those who are poor surgical candidates.
Figure: Left: Origin of the aberrant right subclavian artery Right: Diagonal impression on esophagus from extrinsic compression
Zaid Ansari indicated no relevant financial relationships.
Shehroz Aslam indicated no relevant financial relationships.
Jacob Moussa indicated no relevant financial relationships.
Mustafa Alani indicated no relevant financial relationships.
Andrew Weinberg indicated no relevant financial relationships.
Indu Srinivasan indicated no relevant financial relationships.
Keng-Yu Chuang indicated no relevant financial relationships.
Zaid Ansari, MD1, Shehroz Aslam, MD2, Jacob Moussa, MD2, Mustafa Alani, MD3, Andrew M. Weinberg, DO4, Indu Srinivasan, MD5, Keng-Yu Chuang, MD1. P0379 - Consequences of Going over to the ‘Right’ Side in the Wrong Way: Impact of an Aberrant Subclavian Artery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.