SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: A Rare Cause of Dysphagia in a Young Adult

Pdf Summary

This case report describes a rare adult presentation of double aortic arch causing progressive dysphagia. Double aortic arch is an uncommon congenital vascular anomaly and the most common symptomatic vascular ring, but it is usually diagnosed in infancy because it often causes respiratory or feeding problems. Adult cases are rare and can be missed when symptoms are limited to swallowing difficulty.<br /><br />The patient was a 28-year-old man with a history of hiatal hernia who developed worsening dysphagia to solids and thick liquids over several weeks. His symptoms became severe enough that he depended on a blended or liquid diet. A barium swallow showed extrinsic compression of the upper thoracic esophagus, described as a “waist” at the level of the aortic arch. CT angiography then confirmed a complete double aortic arch forming a vascular ring that compressed the esophagus. Endoscopy also demonstrated pulsatile external compression. Balloon dilation offered only minimal relief.<br /><br />Because the vascular ring was the cause of his symptoms, surgical treatment was recommended. He underwent a left posterolateral thoracotomy through the fourth intercostal space, with ligation and division of the non-dominant left aortic arch. Intercostal cryoablation from T3 to T7 was performed to improve postoperative pain control. His recovery was uncomplicated, and he was discharged home on postoperative day 3.<br /><br />The report emphasizes that vascular anomalies should be considered in the differential diagnosis of dysphagia, especially when imaging suggests external esophageal compression. Early recognition is important because surgical division of the non-dominant arch is the definitive treatment and can significantly improve quality of life.

Asset Subtitle

Carlos Fagundo Jr.

Meta Tag

Author List Carlos Fagundo Jr., Cooper Dodd, Nanette Bentley

Category Clinical Vignettes

Concept Double Aortic Arch

Concept Vascular Ring

Concept Swallowing Impairment

Concept Extrinsic Tumor Compression

Concept Surgical Division

Distinguished Non-Finalist

Presenter Organization Baycare St Joseph's Hospital

Presenting Author Carlos Fagundo Jr.

Track Adult

Keywords

double aortic arch

dysphagia

vascular ring

esophageal compression

adult case report

congenital vascular anomaly

CT angiography

barium swallow

thoracotomy

surgical ligation

Double Aortic Arch

Vascular Ring

Swallowing Impairment

Extrinsic Tumor Compression

Surgical Division