Am J Gastroenterol. Jun;95(6) Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Janssen M(1), Baggen MG, Veen. Dysphagia lusoria is an impairment of swallowing due to compression from an aberrant right subclavian artery (arteria lusoria). Clinical presentation Most. Dysphagia is a relatively common and increasingly prevalent clinical problem, with prevalence of nearly 22% in the adult primary care population and of % .
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July 16, ; Accepted date: August 01, ; Published date: An Uncommon Cause of Dysphagia. J Hepatol Gastroint Dis 2: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author dysphagiq source are credited.
Visit for more related dysphzgia at Journal of Hepatology and Gastrointestinal disorders. We report a case of an uncommon type of dysphagia, due to esophagus compression by an abnormal right subclavian retroesophageal artery. Dysphagia; Arteria lusoria; Aberrant right subclavian artery; Dysphagia lusoria; Esophagus compression. However, it is generally asymptomatic.
Dysphagia lusoria – Wikipedia
This difference seems to be related to the absence of tracheal rigidity in children and the development, with the aging, of physiologic and anatomic changes such as increased stiffness of esophageal and vessel walls [ 2 ]. Dysphagia itself could determine serious problems related to malnutrition, therefore, it is important to recognize this condition as well as to understand the causes, to exclude possible mechanic obstructions due to tumor masses.
A year-old male presented with prolonged history of intermittent dysphagia. The initial presenting symptom was discontinuous dysphagia to solids, which worsened and became more progressive in nature.
In addition, the patient reported a subjective sensation of something blocked in his left chest. Physical examination was unremarkable. Initial investigations, including full blood count and chest plain film, were within normal limits. Due to the persistent symptom, an upper endoscopy was performed and revealed only a mild antral gastritis. He subsequently underwent oral contrast swallow study, which showed smooth extrinsic indentation along posterior esophageal wall at the level of the aortic arch Figure 1.
Frontal esophagram shows an impression black arrow on the left side of the esophagus black star at the level of the aortic arch, caused by the aberrant right subclavian artery. A contrast enhanced Computed Tomography CT of the chest was then acquired and showed a collapsed esophagus enclosed between the trachea on the right, the carotid arteries anteriorly, and the aberrant right subclavian artery posteriorly Figure 2 and 3. Coronal contrast enhanced CECT on posterior view shows a volume rendering image of the aortic arch with an aberrant subclavian artery white star.
Therefore, a diagnosis of dysphagia lusoria was made.
Embryologically, a left aortic arch with aberrant right subclavian artery results from the interruption of the right arch between the right common carotid luaoria and right subclavian artery [ 3 ]. This vessel arises as dyzphagia last great vessel of the aortic arch, from the dorsal margin of the aorta, and steers towards the right arm, crossing the middle line of the body and usually passing behind the esophagus. The main ARSA morphologic types are colored in red. Rarely, this malformation has dysphagiz responsible for dysphagia, as in our case [ 1 ].
It is unknown why dyaphagia patients with ARSA presenting with dysphagia are middle aged or older. According to the current literature this could be related to many possible co-existing conditions: In our case, we suppose that dysphagia resulted from atherosclerosis, which made the artery wall stiffer and then causing compression on the esophagus.
When evaluating patients with dysphagia, the primary and preferred imaging modality is fluoroscopy [ 6 ]. Actually, contrast swallow studies have been recognized for diagnostic screening of dysphagia lusoria [ 7 ].
In this case, esophagogram may show an indentation on the postero-lateral wall of the esophagus at the level and above the aortic arch. To better analyze the causes of this pathological appearance at fluoroscopycross-sectional imaging, such as CT and Magnetic Resonance MRparticularly with vascular reconstruction, will be useful. In fact, they show the vascular lesion and the relationship of the dypshagia mediastinal vessels and structures without the need of conventional catheter angiography [ 13 ].
This latter is not routinely required and may be useful for exact demonstration of vascular anatomy when a surgery therapy is planned [ 28 ].
In addition they aid to exclude other possible causes of extrinsic compression, such as tumor masses involving lung or mediastinal adenopathies [ 6 ]. Among more invasive diagnostic procedure, upper endoscopy dysphqgia shows no significant signs and it is performed to exclude malignant lesion in case of persistent dysphagia. Meanwhile, esophageal manometry frequently reveals nonspecific findings and is unhelpful for the diagnosis [ 2679 ].
In the case we presented, at fluoroscopy there was a quite suspicious narrowing on the posteriorleft side of the esophagus that was confirmed at CT scan, which was necessary to exclude the presence of malignant causes of ab-extrinsic compression. If there is insignificant impact on the nutritional status, in case of mild to moderate symptoms, lusorua condition can be managed conservatively with dietary modification including chewing well and eating slower in smaller bites.
Otherwise, medical treatment with proton pump inhibitor, with or without prokinetic drug, has been used to improve symptoms, as in our case. At last, for patients with severe symptoms, which not benefit from medical strategies, surgical repair and reconstruction of the aberrant vessel should be considered [ 29 ].
The presence of the ARSA should be taken into consideration to distinguish from other causes of dysphagia. In our case the hypothesis that clinically overt arteria lusoria was due to atherosclerotic wall and vessel stiffness supported by older age of symptomatic patients.
Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy.
Dynamic oral contrast swallow studies with confirmatory CT or MRI imaging of vascular lesion remain useful diagnostic imaging tools, with subsequent medical or surgical management relating to the severity of symptoms. The authors declare that no conflict of interest exists with the results and conclusions presented in this paper. Publication ethics have been observed. Ann Jose ankara escort. Please leave a message, we will get back dysphagja shortly. Home Publications Conferences Register Contact.
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