Beyond the Classic Causes of Dysphagia: Bayford-Autenrieth Dysphagia

Abstract

Dysphagia lusoria (DL) is a rare clinical entity that presents with dysphagia derived from the anatomical obstruction of the esophagus by an aberrant vessel originating from the right subclavian artery. We present the case of a 64-year-old patient with a medical history of chronic, intermittent, mild, and self-limited dysphagia for over 20 years, wherein we formulated the diagnosis of DL. A 64-year-old woman arrived at the emergency department with a 24-hour history of acute progressive dysphagia, leading to intolerance to oral intake and minimal exertion dyspnea. A thorough clinical analysis and exclusion of other more common clinical entities will lead to its diagnosis. Our patient presented with respiratory symptoms, which is rare considering that these clinical presentations are more common in the pediatric population, explained by its tracheal elasticity. The combination of respiratory symptoms in an elderly patient, along with the typical mechanical dysphagia of DL, adds complexity to the diagnostic process, making this case unique.

Keywords: acute dysphagia; bayford-autenrieth dysphagia; dyspaghia lusoria; dysphagia; vascular dyspaghia.

Figure 1. This culprit artery is considered "aberrant" as it deviates from the norm; typically, there are only three vessels originating from the aortic arch (A). In the case of an ARSA, the aortic arch is composed of four vessels instead of three (B).

Schematic diagram of the aortic arch with an ARSA

Figure 2. Distal compression of the esophagus by an aberrant vessel (star), which, in turn, causes dilation of the esophagus with remnants of food observed inside and tracheal compression (arrow) (A). Culprit artery originating from the aortic arch following a path toward the right (star) and collapsed esophagus due to vascular compression, also compressing the trachea (arrow) (B).

Contrast-enhanced CT scan of the neck