SHM Converge Scientific Abstract ePoster Gallery-Freak of Nature: A Case of Dysphagia Lusoria

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This case report describes dysphagia lusoria, a rare cause of swallowing difficulty caused by an aberrant right subclavian artery (ARSA) that arises abnormally from the aortic arch and compresses the esophagus. Although the condition is uncommon, it can be asymptomatic in most people and is more often seen in women. The patient was a 74-year-old man with a 20-year history of dysphagia to solids, choking, regurgitation, postprandial cough, and shortness of breath. He could tolerate liquids but needed them to help swallow solids.<br /><br />Initial evaluation, including a modified barium swallow, did not show aspiration. Because of his smoking history, upper endoscopy was performed to exclude cancer; it showed only mild extrinsic compression in the upper esophagus and normal biopsies. The diagnosis was ultimately made by CT angiography, which demonstrated an aberrant right subclavian artery passing behind the esophagus. A fluoroscopic esophagram confirmed smooth extrinsic compression of the posterior esophagus.<br /><br />The discussion reviews the embryologic origin of ARSA and notes that it usually passes behind the esophagus. Late-onset symptoms may result from age-related vascular changes that increase compression. The authors emphasize that barium esophagram is useful for detecting extrinsic compression, endoscopy may be normal but helps rule out other causes, and CT or MRI are definitive for identifying vascular anatomy.<br /><br />Treatment depends on symptom severity. In this patient, management was conservative, with dietary and lifestyle changes such as smaller bites, pureed foods, and water intake with meals. Surgery or dilation is reserved for severe or refractory cases. The report highlights the importance of considering dysphagia lusoria in patients with unexplained dysphagia and normal swallowing studies to avoid delayed diagnosis and unnecessary testing.

Asset Subtitle

Farah Yassine

Meta Tag

Author List Dhruti Mankodi, Farah Yassine, Larry Siu, Mirac Gunay

Category Clinical Vignettes

Concept Dysphagia Lusoria

Concept Aberrant Right Subclavian Artery

Concept Esophageal Compression

Concept Swallowing Impairment

Concept Barium Esophagram

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, Morristown Medical Center

Presenting Author Farah Yassine

Track Adult

Keywords

dysphagia lusoria

aberrant right subclavian artery

ARSA

esophageal compression

dysphagia

CT angiography

barium esophagram

upper endoscopy

extrinsic compression

swallowing difficulty

Dysphagia Lusoria

Aberrant Right Subclavian Artery

Esophageal Compression

Swallowing Impairment

Barium Esophagram