Cardiothoracic Surgery: Fellow Case Report Slide: Cardiothoracic Surgery |

A Rare Cause of Dysphagia FREE TO VIEW

Lelia Logue, MD; Liam Gross, DO; Christopher Jordan, MD; Anthony Saleh, MD; Angelo Reyes, MD
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NY Methodist Hospital, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):45A. doi:10.1016/j.chest.2016.08.052
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SESSION TITLE: Fellow Case Report Slide: Cardiothoracic Surgery

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Wednesday, October 26, 2016 at 11:00 AM - 12:15 PM

INTRODUCTION: Dysphagia is a very common complaint in the outpatient setting. We present a rare cause of dysphagia; dysphagia lusoria.

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.

DISCUSSION: Dysphagia is one of the top complaints in family practice offices with prevalence rates ranging from 6 to 27% in adults. When the initial work up for dysphagia is unrevealing, rare pathologies should be considered.1 An aberrant right subclavian artery (ARSA) occurs in 0.2 to 2% of the population. In ARSA, the right subclavian artery arises distal to the left subclavian artery and usually passes behind the esophagus and trachea. The artery can create a partial or full ring around either of these structures. Ninety percent of adult patients with ARSA remain asymptomatic and most are found incidentally post-mortem.2 Of those with symptoms, 10% usually complain of shortness of breath and dysphagia. An ARSA causing dysphagia was first described by Dr. David Bayford who coined the term Dysphagia Lusoria. If left unrepaired, an ARSA can remain asymptomatic but an aneurysm, aortitis, or ARSA-esophageal fistula can develop.2

CONCLUSIONS: Although dysphagia is a common complaint, clinicians should consider other rare etiologies when initial work up is unrevealing and symptoms are persistent. Dysphagia lusoria is uncommon but may have life-threatening consequences if undiagnosed.

Reference #1: Spieker MR. Evaluating Dysphagia. American Family Physician June 15 2000;61(12):3639-3648

Reference #2: Delap TG. Aneurysm of an Aberrant Right Subclavian Artery Presenting as Dysphagia Lusoria. Annals of Otology, Rhinology & Laryngology 2000;109:231-234

DISCLOSURE: The following authors have nothing to disclose: Lelia Logue, Liam Gross, Christopher Jordan, Anthony Saleh, Angelo Reyes

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