Dysphagia lusoria is an impairment of swallowing due to compression from an aberrant right subclavian artery (arteria lusoria).
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, my 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 non specific and in the same time, diagnostic endoscopy is negative in more than 50% cases, and manometry has no diagnostic role.
Barium study of the oesophagus may show the indentation on the posterior esophageal wall by the artery. Chest X- Ray can demonstrate enlargement of the superior mediastinum .Thus, Angio CT scan and MRI of the thorax are the best diagnostic modalities that could identify the arteria lusoria.
Compression of the oesophagus by the aberrant right subclavian artery can be exacerbated by atherosclerosis or aneurysmal dilatation.
The word lusoria comes from the Greek phrase lusus naturae, meaning freak of nature, which refers to the freaky course of the artery 1.
- 1. Bayford D. An Account of a Singular Case of Deglutition. Memoirs Med Soc London 1794; 2:271.