An Anatomical Cause of Dysphagia
Am Fam Physician. 2020 Feb 15;101(4):241-242.
A 63-year-old man presented for a wellness visit where he reported worsening dysphagia for solids for the past two years. He also had sore throat, dyspnea, cough, heartburn, and wheezing. He did not have weight loss, hematemesis, melena, or chest pain. His medical history was significant for gastroesophageal reflux disease that responded to over-the-counter antacids.
Physical examination findings were normal. A barium study was performed (Figure 1).
Based on the patient’s history, physical examination, and esophagram findings, which one of the following is the most likely diagnosis?
A. Aortic arch aneurysm.
B. Congenital anomaly of the aortic arch.
C. Diffuse esophageal spasm.
D. Esophageal web.
E. Mediastinal mass.
The answer is B: congenital anomaly of the aortic arch. The barium esophagram shows a filling defect in the esophagus that was noted at the level of the aortic arch, suggesting a possible aberrant vessel of the aorta. Computed tomography (CT) confirmed an aberrant right subclavian artery that passed posterior to the esophagus. An aberrant right subclavian artery, or arteria lusoria, is present in 0.5% to 2.5% of the population.1 Dysphagia is the most common symptom, although only 10% of patients with the anomaly are symptomatic.2 The mean age of presentation is 50 years.3 Possible explanations for this patient’s later presentation include aging-associated stiffening of the esophagus and atherosclerosis of the vessel causing compression of surrounding structures.4
The patient was referred for vascular surgery. He underwent right carotid subclavian transposition followed by ligation of the aberrant right subclavian artery.
An aortic arch aneurysm
Referencesshow all references
1. Myers PO, Fasel JH, Kalangos A, et al. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris). 2010;59(3):147–154....
2. Delap TG, Jones SE, Johnson DR. Aneurysm of an aberrant right subclavian artery presenting as dysphagia lusoria. Annals Otol Rhinol Laryngol. 2000;109(2):231–234.
3. Polguj M, Chrzanowski Ł, Kasprzak JD, et al. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations—a systematic study of 141 reports. Scientific World Journal. 2014;2014:292734.
4. Janssen M, Baggen MG, Veen HF, et al. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol. 2000;95(6):14110–1416.
This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.
A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at https://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to email@example.com.
Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions