Arteria lusoria

Clinical History

A 40-year-old woman with a 2-year history of progressive dysphagia and dyspnoea.

Imaging Findings

Contrast enhanced CT shows an aberrant artery with posterior course between the oesophagus and spine, perfusing the right upper extremity, confirming the diagnosis of arteria lusoria.

Discussion

The arteria lusoria is a rare anomaly of the right subclavian artery. This artery arises from the aortic arch distal to the left subclavian artery crossing the midline behind the oesophagus.
Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. [1, 2]

The arteria lusoria is often asymptomatic but 10% of patients can have dysphagia lusoria resulting from oesophageal compression caused by an aberrant right subclavian artery, which was the case in our patient. The dilated proximal ARSA is also known as diverticulum of Kommerell. In some patients this diverticulum may become aneurysmal.
Aortic arch angiography has been the standard for definitive diagnosis of an aberrant right subclavian artery (arteria lusoria). Barium swallow, CT and MR imaging can also be used in the diagnosis. Barium contrast examination of the oesophagus shows indentation on the oesophagus. [3]

Surgical treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation. [4]
In our case, a non-operative treatment with periodic follow-up was chosen based on the asymptomatic character.

Differential Diagnosis List

Final Diagnosis

Arteria lusoria

URL:	https://www.eurorad.org/case/11465
DOI:	10.1594/EURORAD/CASE.11465
ISSN:	1563-4086