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.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to ourcustomers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form.Please note that during the production process errors may be discovered which could affect thecontent, and all legal disclaimers that apply to the journal pertain.

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: catarinatalaiamartins@gmail.com

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.