An Unusual Dysphagia for Solids in a 17-Year-Old Girl Due To a Lusoria Artery: A Case Report and Review of the Literature

Abstract

Background: Dysphagia is a condition that can have many underlying causes, often different between adults and children and its early diagnosis is crucial especially during childhood and adolescence, given the importance of proper nutritional intake to ensure adequate growth and development. Case report: We described the case of a 17-year-old girl reporting dysphagia for solids for approximately one month. No symptoms were previously referred. Oesophagogastroduodenoscopy was performed, detecting an image of ab extrinseco compression at the level of the mid-cervical oesophagus. An upper gastrointestinal tract radiography confirmed an oesophageal impression above the arch of the aorta suggestive of vascular abnormality. Computed tomography angiography and three-dimensional reconstruction techniques showed the presence of a lusoria artery that originated from the medial margin of the descending aorta and crossed the trachea and oesophagus posteriorly to the distal third. The lusoria artery was transected via a left thoracotomy and re-implanted into the right common carotid artery with complete symptom resolution. Conclusions: Dysphagia lusoria is an impairment of swallowing due to compression from an aberrant right subclavian artery. The diagnosis is always difficult, as the symptoms are often nonspecific. It is imperative to accurately identify and properly manage dysphagia in pediatric age and this is only possible with an anamnestic, clinical and instrumental process that takes into account an adequate differential diagnosis.

Keywords: computed tomography angiography dysphagia; lusoria artery; nutrition; oesophagogastroduodenoscopy.

Figure 1

(A) Oesophagogastroduodenoscopy showing an image of an ab extrinseco compression of the mid-cervical oesophagus. (B) Upper gastrointestinal tract radiography confirming an oesophageal impression above the arch of the aorta. (C) Computed tomography angiography and (D) three-dimensional visualization, which detect the presence of a lusoria artery originating from the medial margin of the descending aorta and crossing the trachea and oesophagus posteriorly to the distal third, resulting in a tortuous appearance.