Aggravation of Dysphagia aortica after wearing the abdominal binder

Abstract

Dysphagia aortica is a rare etiology of dysphagia resulting from extrinsic compression of esophagus by thoracic aortic aneurysm or tortuosity and elongation of thoracic aorta. The clinical findings resemble those of esophageal malignancy or esophageal motility disorders. Therefore, primary diagnosis of dysphagia aortica is very difficult. We, herein, report a case of dysphagia aortica aggravated by wearing the abdominal binder in a 70-year-old woman and review the literature pertaining to this condition. Dysphagia aortica should be considered in the differential diagnosis of dysphagia.

Keywords: Abdomen; Aortica; Deglutition disorder; Equipment; Manometry.

Figure 1

Upper gastrointestinal endoscopic finding. Endoscopy shows a pulsatile extrinsic compression at about 40 cm from the incisor. The underlying esophageal mucosa appears entirely normal. Endoscope has been introduced through the narrowing lumen with mild resistance.

Figure 2

Upper gastrointestinal barium study. An upper gastrointestinal barium study shows the extrinsic indentation of distal esophagus (arrow) and mild passage disturbance.

Figure 3

Chest computed tomography (CT). The chest CT scan shows the enlargement of left atrium and tortuous thoracic aorta with mild compression into adjacent esophagus (arrow).

Figure 4

Esophageal manometric findings. (A) Esophageal manometry reveals a localized high pressure barrier (arrow) with superimposed oscillations synchronous with aortic pulsating typically seen in only one transducer. And also, intermittent interruption of peristalsis of (50% nontransmitted contraction) and low amplitude of esophageal body are noted (arrowhead). (B) Manometry shows more improvement peristaltic swallow activity and low amplitude of esophageal body after taking off her abdominal binder.