S2032 Dysphagia Lusoria: A Rare Case of Progressive Dysphagia

Abstract

Introduction: Deviations from the classic anatomic configuration of the aortic arch are common. An aberrant right subclavian artery is one known anatomic variant that rarely causes symptoms. Here we describe a case in which a patient presents with progressive dysphagia and is found to have retroesophageal compression due to aberrant right subclavian artery and anterior cervical osteophytes. Case Description/Methods: A 61-year-old female with a medical history of invasive ductal carcinoma of the left breast reports with dysphagia and odynophagia for one year. Initially her symptoms began with solids, but then progressed to liquids. Patient underwent CT soft tissue neck which showed an aberrant right subclavian artery compressing the posterior aspect of the esophagus near the level of the thoracic inlet as well as cervical anterior osteophytes leading to compression of the esophagus at the upper cervical aspect. She underwent barium Esophagram which also showed indentation in the posterior esophagus which was later directly confirmed by EGD. At this time, patient has been referred to vascular surgery for further management. Discussion: Aberrant right subclavian artery, or arteria lusoria, is one of the most common abnormalities of the aortic arch. The aortic arch usually branches off into the left subclavian artery, the left common carotid artery, and the brachiocephalic artery which further branches into the right common carotid and right subclavian artery. When arteria lusoria is present, the brachiocephalic artery is absent, and the right common carotid artery and right subclavian artery originate directly from the aortic arch with the latter having a distal left sided origin. Rarely, this anatomic variant can lead to compression of the esophagus and produce a condition known as dysphagia lusoria which was first described by Dr. David Bayford in 1787 in a woman with long term dysphagia after autopsy, thus it is also known as Bayford-Autenrieth dysphagia. Most patients present with symptoms in middle age or older, with mechanisms such as increased tracheal rigidity and elongation of the aorta theorized. In the case of our patient, anterior cervical osteophytes development may have contributed to symptom onset. A variety of surgical approaches for arteria lusoria are available with surgical or endovascular approaches available.Figure 1.: Imaging of our patient with dysphagia. A) Axial and B) Sagittal images of the CT soft tissue of the neck showing aberrant origin of right subclavian artery (blue bold arrow) with abnormal course behind the esophagus (red curved arrow). C) Barium esophagograms performed demonstrated extrinsic impression upon the cervical esophagus posteriorly (yellow bold arrow) causing dysphagia.