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Case Reports
. 2022 Jul;38(4):438-441.
doi: 10.1007/s12055-022-01348-9. Epub 2022 Apr 7.

Caught in a vice

Vipin Dulam  1   2 , Suresh Keshavamurthy  3 , Maruti Kumaran  1 , Partha Hota  1 , Carlos Gutierrez  1 , Mohammed Abul Kashem  1 , Yoshiya Toyoda  1
Affiliations
Case Reports

Caught in a vice

Vipin Dulam et al. Indian J Thorac Cardiovasc Surg. 2022 Jul.

Abstract

Esophageal dysmotility and dysphagia are well known in patients with scleroderma. Interstitial lung disease (ILD) in these patients is an indication for lung transplantation but is considered high risk in many centers. This report is an attempt to highlight how anatomical causes can contribute to dysphagia in such patients and complicate the post-operative course after lung transplantation. Such a finding is uncommon in this subset of patients and use of suitable imaging can help in arriving at the diagnosis. We present a patient following lung transplantation for scleroderma related ILD with an aberrant right subclavian artery compressing the esophagus in a vice like grip. Imaging is the key to prompt diagnosis and management.

Keywords: Aberrant right subclavian artery; Esophageal compression; Feeding difficulties; Lung transplantation.

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Conflict of interest statement

Conflict of interestThe Authors report no conflicts of interest for this manuscript.

Figures

Fig. 1
Fig. 1
a Posterior view reconstruction of CT at level of aortic arch. Esophagus is shown in red with aberrant right subclavian artery shown wrapping around the esophagus and compressing it. Here we can see the branches of the aorta. The first is a bovine arch giving rise to the right common carotid and the left common carotid. The second branch is the left subclavian artery. b Left lateral view reconstruction of CT at level of aortic arch. Esophagus is shown in red. The bovine arch is shown in this image. The ARSA which is the third branch from the aortic arch takes a hairpin-like turn and dives medially thus traveling posterior to the esophagus and indenting it along its course
Fig. 2
Fig. 2
a Here, we see an axial cross section of the thorax providing a view of the aberrant subclavian artery (the radiolucent structure) traversing posterior to the esophagus.. Posterior to the trachea is the esophagus compressed by the aberrant subclavian artery. b This cross sectional view of the thorax demonstrates the ARSA in relation to the left subclavian artery- two separate branches but they are remarkably close in their origin from the aorta
Fig. 3
Fig. 3
a A coronal slice of the CT scan showing us the exact location of the ARSA- around the level of the tracheal bifurcation (T4). This view also demonstrating the esophagus being impinged by the ARSA. b Modified barium Swallow- The contrast stream is observed narrowing in the esophagus demonstrating that this is esophageal indentation. The oblique course of the ARSA is what gives the impression of the ‘wide’ indentation
See this image and copyright information in PMC

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