CASE PRESENTATION: A 24 year old female presented with complaints of one year of dysphagia, weakness, cramping abdominal pain and fatigue. Since age twelve, she suffered from intermittent dysphagia to solids, neck stiffness and right sided pressure-like headaches. She previously had not sought medical attention for her symptoms due to their intermittent nature. At twenty-three, she was started on famotidine without significant relief. One year later she presented to the office where a bilateral blood pressure measurement revealed a discrepancy. Right radial pulsation was slightly diminished as compared to the left; otherwise, her exam was unremarkable. A CT chest angiogram revealed her right subclavian artery arising from the aortic arch distal to the left subclavian artery, crossing posterior to the esophagus with no proximal esophageal dilatation. She is scheduled for an open thoracotomy and surgical repair of the aberrant vessel.