Dysphagia Lusoria: A Little Known Cause of Chest Pain

Abstract

Dysphagia lusoria is a congenital abnormality characterized by an aberrant right subclavian artery. It often presents as either an incidental finding on imaging or chronic dysphagia. We describe the case of a 66-yearold female who presented with severe chest pain, worse with swallowing, along with an ongoing globus sensation. She was found to have a negative cardiac workup for ischemia with a subsequent computed tomography angiogram (CTA) of the chest showing an abnormal right subclavian artery. We emphasize the unique diagnostic approach of this rare anatomical anomaly and its potential presentation that worsens with deglutition.

Surgical repair of severe dysphagia lusoria

“… 4 In most cases, the aberrant right subclavian artery courses posteriorly to the esophagus and can be associated with a Kommerell diverticulum (not present in our patient). 2 , 5 Again, the incidence of an anomalous right subclavian artery is quite rare and has been reported to be ∼0.4% to 1.8% in the general population. Therefore, the surgical indications have not been well defined.…”

Dysphagia Lusoria Causing Aspiration Pneumonitis in a Patient With Recurrent Pancreatitis

“…It is thought that late-onset symptoms of DL are attributed to progressive esophageal stiffness and decreased motility as a product of aging. Additionally, age-related atherosclerosis can lead to vascular alterations, including ARSA stiffening, aortic elongation, or dilation of Kommerell's diverticulum, all of which can contribute to more pronounced esophageal compression [1,5].…”

“…The most commonly reported symptom in adults includes those associated with mechanical esophageal obstruction, progressively worsening dysphagia (91%), regurgitation of poorly chewed food, chest pain, postprandial bloating, and coughing, or Horner's syndrome. Chest pain was one of the least reported symptoms (<20%), followed by a rare case of ruptured aneurysmal rupture of the Kommerell diverticulum [5,7].…”

“…Approximately 80% of ARSAs project between the esophagus and the vertebral column, 15% of ARSAs course between the esophagus and the trachea, and only 5% of ARSAs run anteriorly to the trachea and the esophagus [2]. Commonly, an ARSA is complicated by having a wide base, known as Kommerell's diverticulum, which can widen in the context of aging [5]. The diagnosis of dysphagia lusoria is characterized as having esophageal compression, with resulting dysphagia, odynophagia, and/or reflux secondary to an ARSA, such as in the patient reported herein.…”