Dysphagia lusoria: a late onset presentation

Abstract

Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric changes may contribute to clinically relevant dysphagia lusoria in patients who present later in life. Our report describes a case of late-onset dysphagia secondary to a right aortic arch with an aberrant left subclavian artery, which represents a rare variant of dysphagia lusoria. The patient had proven additional oesophageal dysmotility with solid bolus only and a clinical response to dietary modification.

Keywords: Dysmotility; Dysphagia; Dysphagia Lusoria; Endoscopy; Oesophagus.

Figure 1

Manometry study demonstrating a high pressure band in the lower oesophagus (at the 360 mm mark/36 cm) consistent with arterial pulsations. This pressure band does not manometrically cause obstruction with a clear relaxation across the region of interest during the swallow.

Figure 2

Barium oesophogram demonstrating the extrinsic impression on the oesophagus secondary to the aberrant left subclavian artery superiorly and right aortic arch distally.

Figure 3

Computed tomography chest demonstrating the right aortic arch and dilatation at the origin of the aberrant left subclavian artery (Komerrell’s diverticulum).