Right aortic arch with left descending aorta: a rare cause of dysphagia

Abstract

Aortic abnormalities are a rare cause of dysphagia in children, adolescents, young adults and in the elderly. In these cases, vascular abnormalities commonly include aberrant right subclavian artery, left subclavian artery originating from the right aortic arch and, more rarely, from the right aortic arch with thoracic aorta on the left. Dysphagia, also known as "dysphagia lusoria", is due to the compression of the esophagus caused by one or several congenital vascular abnormalities and can occur in childhood or later in adulthood. Upper gastrointestinal series show extrinsic compression of the esophagus and thoracic angiography (scanner or magnetic resonance imaging (MRI)) is used to confirm the diagnosis. In a few cases, surgical treatment is often required. We here report the case of a 30-year old female patient, with no previous medical or surgical history, presenting with dysphagia to solid foods of recent onset, without other associated symptom. Physical examination showed good general condition. The patient underwent upper gastrointestinal series revealing extrinsic esophageal compression, then chest X-ray and chest MRI showing right aortic arch with left descending aorta, without situs inversus. Finally, echocardiography was performed which excluded associated congenital heart disease. Outcome was marked by spontaneous regression of dysphagia.