Dysphagia lusoria

Clinical History

We report a case of a 23-year-old female, with a complaint of dysphagia for solid food in the past one mouth. A barium oesophagography when done showed, in the upper third of the thorax, the presence of a linear extrinsic compression in the posterior wall, running cephalad from the left to the right. The diagnosis of dysphagia lusoria was proposed.

Imaging Findings

Our patient was a 23-year-old female who came to us complaining of dysphagia for solid food, for the past one month. The patient said that the swallowing difficulties were localized in the upper third of the thorax, and she had no other complaint like weight loss or odynophagia. The results of a physical examination of the patient, and the laboratory data were found to be normal. Using single contrast oesophagography, we observed, in the frontal projection, a sharply defined lucency, beginning at the lower margin of the fourth thoracic vertebra and running cephalad from the left to the right. In the lateral projection, this lucency had a posterior localization, passing between the oesophagus and fourth thoracic vertebra (Fig. 1,2). On the basis of these results, the diagnosis of an aberrant right subclavian artery, causing dysphagia lusoria, was made.

Discussion

In some cases, the right subclavian artery does not arise from an innominate trunk with the right carotid artery, but originates as the last brachiocephalic branch from the descending aorta and takes a retroesophageal route to its destination (1). This is the most common of the arch vessel anomalies, occurring in about 0.5% of the population (1). An aberrant right subclavian artery is the last major vessel originating from the aortic arch and arises distal to the left subclavian artery, causing a linear, sharply marginated, extrinsic compression on the posterior wall of the oesophagus (2). In the frontal projection, this frequently appears as a sharply defined lucency on the single-contrast oesophagogram, beginning at the lower margin of the fourth thoracic vertebra and running cephalad from the left to the right (3). Computerized tomography (CT) scan, magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) can be useful diagnostic tools because they reveal the positions of vascular, tracheobronchial, and oesophageal structures and their relationships to one another (4). Although these modalities provide an excellent delineation of all of the associated structures, they should be reserved for cases in which the results of the barium oesophagram do not provide a clear diagnosis (4). In patients with vague symptoms of difficulty in swallowing, the clinician should not regard the presence of a left aortic arch with retroesophageal right subclavian artery as the definitive cause of the patient's symptoms. Reports of surgical division of the anomalous retroesophageal right subclavian artery for the treatment of such symptoms appear in older surgical literature. This was found to be an ineffective treatment, because the majority of these patients continued to have symptoms. Currently, the presence of this anomaly is not believed to be the cause of such symptoms, and the clinician should continue further diagnostic studies (5).

Differential Diagnosis List

Final Diagnosis

Dysphagia lusoria secondary to an aberrant right subclavian artery.

URL:	https://www.eurorad.org/case/3995
DOI:	10.1594/EURORAD/CASE.3995
ISSN:	1563-4086