Contained Rupture of a Thoracic Aortic Aneurysm: A Rare and Life-Threatening Cause of Dysphagia

Abstract

Dysphagia is commonly seen in the elderly and has both benign and malignant causes. A difficulty in swallowing due to the esophageal compression by the aorta, or dysphagia aortica, is a rare entity, little described in literature. However, diagnostic error or diagnostic and treatment delays of aortic dysphagia can be fatal. Herein, we report a case of dysphagia aortica caused by the contained rupture of a descending aneurysmatic thoracic aorta, presenting at the emergency department with acute dysphagia and diffuse chest pain, successfully treated by thoracic endovascular aneurysm repair.

Keywords: contained rupture of aortic aneurysm; dysphagia aortica; dysphagia at the emergency departement; rare cause of dysphagia; rare presentation of thoracic aortic aneurysm.

Figure 1. Oral gastrografin contrast study.

Oral gastrografin contrast study showing mediastinal widening, esophageal narrowing at the left lateral aspect of the proximal to mid esophagus and deviation of the esophagus to the right, due to external compression by the aneurysm and its mediastinal contained hematoma.

Figure 2. Contrast-enhanced computed tomography.

Contrast-enhanced computed tomography of the chest demonstrating an acute contained ruptured thoracic aortic aneurysm with considerable compression of the esophagus by a voluminous mediastinal hematoma. Diameters of the descending aorta and the surrounding periaortic hematoma are respectively 67 x 64 mm and 78 x 70 mm.