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Dysphagia lusoria
Simon Phillpotts1, Alexander Azizi2, Matthew Train3, Steven Mann4
1Barnet General Hospital, Specialty Registrar, Gastroenterology, The Royal Free London NHS Foundation Trust, London, United Kingdom
2Barnet General Hospital, Foundation Doctor, Gastroenterology, The Royal Free London NHS Foundation Trust, London, United Kingdom
3Barnet General Hospital, Consultant, Radiology, The Royal Free London NHS Foundation Trust, London, United Kingdom
4Barnet General Hospital, Consultant, Gastroenterology, The Royal Free London NHS Foundation Trust, London, United Kingdom

Article ID: 100906Z01SP2018
doi: 10.5348/100906Z01SP2018CL

Corresponding Author:
Alexander Azizi,
Targeted Therapy Group, Manchester Cancer Research Centre,
The University of Manchester, 555 Wilmslow Road,
Manchester, M20 4GJ, United Kingdom

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Phillpotts S, Azizi A, Train M, Mann S. Dysphagia lusoria. Int J Case Rep Images 2018;9:100906Z01SP2018.


CASE REPORT

A 43-year-old lady with no past medical history was referred with five weeks of dysphagia and weight loss. She experienced food sticking retrosternally with associated pain radiating to her back. She was only able to tolerate a liquid diet and had subsequently lost nine kilograms of weight in five weeks.

Physical examination was unremarkable. Her screening blood tests and abdominal ultrasound were normal. An oesophago-gastro-duodenoscopy (OGD) was performed which showed an entirely normal upper gastrointestinal tract.

She subsequently underwent a computed tomography (CT) scan of her thorax, abdomen and pelvis and barium swallow. The CT demonstrated the aberrant right subclavian artery causing compression of the proximal oesophagus (Figure 1). This aberrant vessel was subsequently demonstrated causing a vascular impression of the mid oesophagus on barium swallow (Figure 2A and B).

She has been managed conservatively, as definitive treatment would involve major vascular reconstructive surgery.

Keywords: Barium, Dysphagia, Dysphagia lusoria, Subclavian



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Figure 1: An axial non-contrast computed tomography scan of the patient’s thorax. The compressed oesophagus and aberrant right subclavian artery are highlighted with green arrows.


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Figure 2(A and B): Anterior and lateral views of a barium swallow examination displayed on radiographs. Barium causes substantial attenuation of X-rays and so allows the visualisation of the oesophagus after it has been swallowed. The image on the left is an anterior view of the barium swallow examination with a green arrow marking the indentation on the oesophagus by the right subclavian artery. The image on the right is a lateral view of the barium swallow examination with a green arrow marking the indentation on the oesophagus by the right subclavian artery.


DISCUSSION

Dysphagia lusoria is a rare cause of dysphagia. It is caused by an aberrant course of the right subclavian artery [1]. It is thought to occur due to abnormal involution or absence of the 4th right arch of the aorta during early embryological development. This anomaly causes the right subclavian artery to branch from the abdominal aorta distal to the left subclavian and therefore cross the midline, predominately adjacent to the oesophagus [2], [3]. The incidence of this aberrant right subclavian artery is reported as between 0.3 to 1.8% [4] ,[5]. Usually this anomaly does not cause symptoms. However, 20–40% of aberrant arteries are reported to cause trachea-oesophageal symptoms; the mean age of presentation is between 40–48 years old [1]. Manometric abnormalities may contribute to dysphagia in older patients [5]. Barium swallow classically shows a posterior, oblique indentation of the oesophagus. Contrast-enhanced computed tomography typically confirms the diagnosis. Symptomatic dysphagia lusoria can be treated with proton-pump inhibitors and dietary modification, or surgically with ligation and transposition to the right carotid artery [6].


CONCLUSION

Dysphagia lusoria is a rare cause of dysphagia. It is caused by an aberrant course of the right subclavian artery, which compresses the oesophagus and causes dysphagia.


REFERENCES
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  3. Carrizo GJ, Marjani MA. Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 2004;31(2):168–71.   [PubMed]    Back to citation no. 3
  4. Rogers AD, Nel M, Eloff EP, Naidoo NG. Dysphagia lusoria: A case of an aberrant right subclavian artery and a bicarotid trunk. ISRN Surg 2011;2011:819295.   [CrossRef]   [PubMed]    Back to citation no. 4
  5. Bennett AL, Cock C, Heddle R, Morcom RK. Dysphagia lusoria: A late onset presentation. World J Gastroenterol 2013 Apr 21;19(15):2433–6.   [CrossRef]   [PubMed]    Back to citation no. 5
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Author Contributions
Simon Phillpotts – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alexander Azizi – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Train – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Steven Mann – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this clinical image.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Simon Phillpotts et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.