CASE 15694 Published on 20.04.2018

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

D. Campos Correia, E. Bandeira, F. Cruz, R. Cabral, I. Amaral

Centro Hospitalar de Lisboa Ocidental;
Rua da Junqueira, 126
1349-019 Lisboa, Portugal;
Email:davidcorreia7@gmail.com

Patient

40 years, female

Categories

Area of Interest Arteries / Aorta ; Imaging Technique Conventional radiography, CT ;

Procedure Diagnostic procedure ; Special Focus Arteriovenous malformations ;

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Clinical History

A 40-year-old otherwise healthy woman presented with a long-standing history of mild dysphagia to solids. Fiberoptic endoscopic evaluation and upper gastrointestinal endoscopy were unremarkable.

Differential Diagnosis List

Dysphagia lusoria

Tumour

Gastro-oesophageal reflux disease

Imaging Findings

A barium swallow was performed revealing an oblique indentation of the upper oesophagus with a left-to-right trajectory, consistent with an aberrant right subclavian artery (Fig. 1 a, b). CT angiography confirmed the presence of an aberrant right subclavian artery arising distally from the aortic arch with a retro-oesophageal course, slightly compressing the oesophagus (Figure 2 a, b and c).

Discussion

Aberrant origin of the right subclavian artery is the most frequent developmental anomaly of the aortic arch [1]; however, it does not usually cause oesophageal impairment [1]. In these cases, such an entity is termed dysphagia lusoria. Adult onset is extremely rare [2]. Surgery is reserved for patients with prominent symptoms or aneurysmal dilation. Re-establishment of flow by reimplantation or bypass is currently the method of choice [3].
Because the dysphagia was only mild, no surgical correction was performed.

References

[1] Carrizo GJ, Marjani MA (2004) Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 31:168–71 (PMID: 15212130)

[2] D. Rogers, M. Nel, E. P. Eloff, N. G. Naidoo (2011) Dysphagia Lusoria: A Case of an Aberrant Right Subclavian Artery and a Bicarotid Trunk. ISRN Surg 2011: 819295 (PMID: 22084776)

[3] Yuksel Atay, Cagatay Engin, Hakan Posacioglu, Ruhi Ozyurek, Coskun Ozcan, Tahir Yagdi, Fatih Ayik, Emin Alp Alayunt (2006) Surgical Approaches to the Aberrant Right Subclavian Artery. Tex Heart Inst J 33(4): 477–481 (PMID: 17215974)

Case information