Endoscopic Diagnosis of Dysphagia Lusoria

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Dysphagia Lusoria is a condition illustrated by difficulty in swallowing secondary to an aberrant right subclavian artery arising from the distal aortic arch and progressing posteriorly to the esophagus. The course of the artery forms a band that narrows the mid-esophagus. We present a case of a patient with a history of dysphagia and a presumed diagnosis of an esophageal stricture based on a barium swallow study. She was undergoing repeated balloon dilations of the “esophageal narrowing” without symptom relief. The patient sought a second opinion in thoracic surgery. A pulsatile band along the posterior esophagus was noted on endoscopy. Subsequently, a CT angiography confirmed the diagnosis of an aberrant right subclavian artery and surgical repair with a right subclavian and carotid bypass was performed. Afterwards, the patient’s dysphagia was still resolved, and at one year follow up the patient remained symptom free. In today’s age of frequent endoscopic intervention, uncommon etiologies for dysphagia should be considered in the differential diagnosis. If a pulsatile band along the mid-posterior esophagus is noted on endoscopy, an aberrant right subclavian artery should be in the differential. In this situation, surgical intervention and not an endoscopic procedure is the definitive treatment.