Dysphagia lusoria: a little-known cause of dysphagia · 2018-01-17 · IPD 5385 Dysphagia lusoria:...
Transcript of Dysphagia lusoria: a little-known cause of dysphagia · 2018-01-17 · IPD 5385 Dysphagia lusoria:...
Title:Dysphagia lusoria: a little-known cause ofdysphagia
Authors:Catarina Atalaia-Martins, CláudiaGonçalves, Isabel Cotrim, Vitor Pardal
DOI: 10.17235/reed.2018.5385/2017Link: PubMed (Epub ahead of print)
Please cite this article as:Atalaia-Martins Catarina, GonçalvesCláudia, Cotrim Isabel, Pardal Vitor.Dysphagia lusoria: a little-known cause ofdysphagia. Rev Esp Enferm Dig 2018. doi:10.17235/reed.2018.5385/2017.
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IPD 5385
Dysphagia lusoria: a little-known cause of dysphagia
Catarina Atalaia-Martins1, Cláudia Gonçalves1, Isabel Cotrim1 and Vitor Pardal2
Departments of 1Gastroenterology and 2Radiology. Centro Hospitalar Leiria. Portugal
Correspondence: Catarina Atalaia-Martins
e-mail: [email protected]
Key words: Dysphagia lusoria. Arteria lusoria. Esophagus.
CASE REPORT
An 82-year-old female was referred for the evaluation of progressive esophageal
dysphagia of a six month duration, with a recent weight loss of 10% of the normal
corporal weight over a six month period. The patient reported solid food dysphagia
that required liquids to facilitate food progression and denied food impaction. An
upper endoscopy revealed an extrinsic impression in the upper esophagus at 25
centimeters from the incisors. A barium esophagram identified contour irregularity of
the upper esophagus caused by an extrinsic compression above the aortic arch (Fig. 1).
Thoracic computed tomography (CT) showed an aberrant right subclavian artery
arising as the fourth branch of the aortic arch (Figs. 2 and 3) with a retroesophageal
course from left to right, which compressed the esophagus and caused a moderate
reduction of the esophageal caliber. These findings were compatible with a diagnosis
of dysphagia lusoria. The patient refused a referral for surgery and was advised about
dietary modifications. After three months, she had a favorable evolution with a
symptomatic improvement and weight stabilization.
DISCUSSION
Dysphagia lusoria is caused by compression of the arteria lusoria, an aberrant right
subclavian artery. It is usually asymptomatic but can become symptomatic in the case
of a compression of the esophagus or the trachea, in the presence of an aberrant
subclavian artery aneurysm and with advanced age. This is possibly due to
atherosclerotic hardening or fibromuscular dysplasia of the arteries (1). Mild to
moderate symptoms are often treated with a dietary modification (2). In case of
severe or persistent symptoms, surgical intervention is required to remove the
aberrant vessel and reconstruct the vascular supply. In addition, less invasive
techniques are now available, such as vascular endoprosthesis and endovascular
occlusion. The initial results of these procedures are promising (3).
REFERENCES
1. Myers PO, Fasel JHD, Kalangos A, et al. Arteria lusoria: Developmental anatomy,
clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2010;59(3):147-
54. DOI: 10.1016/j.ancard.2009.07.008
2. Levitt B, Richter JE. Dysphagia lusoria: A comprehensive review. Dis Esophagus
2007:455-60. DOI: 10.1111/j.1442-2050.2007.00787.x
3. Jalal H, El Idrissi R, Azghari A, et al. Dysphagia lusoria: Report of a series of six
cases. Clin Res Hepatol Gastroenterol 2014;38(3):e45-9.
Fig. 1. Barium esophagram showing a supra-aortic esophageal compression.
Fig. 2. Aberrant right subclavian artery arising as the fourth branch of the aortic arch
on thoracic CT.
Fig. 3. Thoracic CT tridimensional reconstruction showing an aberrant right subclavian
artery.