Lusory dysphagia: Unusual cause of intermittent dysphagia

Abstract

Introduction and importance: Lusory dysphagia (LD) is a rare disorder resulting from extrinsic vascular compression of the esophagus, is often associated with an aberrant right subclavian artery (ARSA). LD is characterized by abnormal development of the right fourth aortic arch during embryonic stages, leading to posterior coursing of the artery in 80 % of cases. Predominantly presenting as dysphagia, LD can occasionally manifest with laryngeal stridor or dyspnea, yet it often remains asymptomatic and incidentally discovered.

Case presentation: We present a case of LD in a 24-year-old male with Down syndrome, experiencing prolonged dysphagia and recurrent aspiration episodes. Emergency upper gastrointestinal endoscopy revealed food impactation beyond the upper esophageal sphincter, and subsequent imaging studies confirmed an aberrant right subclavian artery causing extrinsic compression.

Discussion: LD is a rare condition. It is a challenging diagnosis often necessitating a combination of endoscopy, contrasted imaging and angiography. Treatment strategies vary, with conservative approaches for mild symptoms involving dietary modifications, and surgical intervention considered for persistent or severe cases.

Conclusion: Recognizing LD in the context of long-standing dysphagia is crucial for accurate diagnosis and appropriate management. Further research is needed to establish standardized diagnostic and therapeutic guidelines for this uncommon condition.

Keywords: Aberrant subclavian artery; Lusory dysphagia.

Fig. 1

Chest computed tomography angiography. A. Depicts a transverse section showcasing the emergence of the aberrant right subclavian artery from the aorta (*). B, C, and D. Display axial sections delineating the trajectory of the aberrant right subclavian artery (*) posterior to the trachea and esophagus (white arrow), resulting in subsequent extrinsic compression of the esophagus.

Fig. 2

Esophagogram with water-soluble contrast. This image illustrates extrinsic compression at the level of the thoracic esophagus, resulting in a narrow lumen through which the contrast material is able to pass.