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Dysphagia lusoria

Dysphagia lusoria is an impairment of swallowing due to compression from an aberrant right subclavian artery (arteria lusoria).

Clinical presentation

Most patients with aberrant right subclavian arteries do not have symptoms. Some present with mild dysphagia, while a small minority have a severe enough disturbance in swallowing that leads to inability to swallow and severe nutritional problems.

In children, the most common presentations are stridor and recurrent chest infections, may be due to their tracheal softening comparing to adult population.

The diagnosis of dysphagia lusoria is always difficult and late as the symptoms are often nonspecific and in the same time, diagnostic endoscopy is negative in more than 50% cases, and manometry has no diagnostic role.

Compression of the oesophagus by the aberrant right subclavian artery can be exacerbated by atherosclerosis or aneurysmal dilatation.

Radiographic features

Chest radiograph

Chest x-ray can demonstrate enlargement of the superior mediastinum

Fluoroscopy

Barium study of the oesophagus may show the indentation on the posterior esophageal wall by the artery. 

CT/MRI

CT angiography and MRI thorax are the best diagnostic modalities that could identify the arteria lusoria.

History and etymology

The word lusoria comes from the Latin phrase lusus naturae, meaning "freak of nature", which refers to the anomalous course of the artery 1.

Differential Diagnosis

As adult onset of dysphagia lusoria is rare, it should prompt evaluation for other reasons such as malignancy, vascular disease or gastro-oesophageal reflux disease (GORD) 3,4,5.

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