Dysphagia Lusoria: A Case of an Aberrant Right Subclavian Artery and a Bicarotid Trunk

Abstract

Dysphagia Lusoria is dysphagia secondary to an aberrant right subclavian artery that has a retroesophageal course. Adachi and Williams categorized aortic arch anomalies, showing that the right subclavian artery arising in this fashion (as the final branch of the descending aortic arch) is one of the more common. However, this very rarely coexists with a bicarotid trunk. We present such a case as it is manifested in a 36-year-old lady complaining of marked weight loss and dysphagia. The diagnosis remained elusive until a CT scan of the chest was performed; angiography further delineated the pathology. It is believed that the combination of the common carotid origins with the retroesophageal course of the aberrant vessel more frequently accounts for symptoms in the absence of an aneurysm of the origin of the aberrant vessel. Several techniques to manage the aberrant vessel have been described in the literature, but we favoured open ligation and transposition to the right carotid artery.

Unusual symptomatic late onset presentation of aberrant right subclavian artery: report of two cases and short literature review

“…When symptoms persist then a surgical approach relieves symptoms in most cases [13]. Surgical technique should be personalised according to the anatomical variants of the ARSA [3,11,13].…”

“…Many different surgical accesses have been decribed such as median sternotomy [18], left or right thoracotomy [19], cervical [12] or right supraclavicular [3,11,12]. Lately endovascular or hybrid approach with promising early results [20].…”

“…However, the first case of ARSA causing dyphagia was described in 1733 [3] and the first radiologic description was made in 1936 by Kommerell [4,5]. In this situation, the right subclavian artery does not originate from brachiocephalic trunk, but distally and dorsally of the left subclavian artery [3]. Therefore, it typically has retroeophageal course and proceeds between the esophagus and spine in the 80% of the cases [6][7][8].…”

“…Lusoria comes from the Latin "lusus naturae" meaning "freak nature" [2]. However, the first case of ARSA causing dyphagia was described in 1733 [3] and the first radiologic description was made in 1936 by Kommerell [4,5]. In this situation, the right subclavian artery does not originate from brachiocephalic trunk, but distally and dorsally of the left subclavian artery [3].…”

“…This broad base of the ARSA is known as Kommerel's diverticulum [5,9]. Commonest symptoms include dyspnea during childhood and dysphagia mainly for solid food with aging [3,6] (Table 1). In this article, we report two cases of late onset presentation of symptomatic ARSA.…”