Dysphagia lusoria

Last revised by Bahman Rasuli on 3 Jul 2023

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 cough during swallowing that leads to a disturbed swallow and severe nutritional problems.

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

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

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

Chest radiographs can demonstrate enlargement of the superior mediastinum shadow. 

Barium study of the esophagus can show the indentation on the posterior esophageal wall by the artery. 

CT angiography and chest MRI are the best diagnostic modalities that can detect the arteria lusoria.

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

The term was coined by the English surgeon, David Bayford (1739-90) when he described the case of a female patient with "obstructed deglutition" due to an anomalous subclavian artery. Bayford, whilst still an apprentice surgeon, attended the patient's autopsy in 1761, at which he found the anomalous arterial course. In his described case the artery passed between the trachea and esophagus which is the second commonest course. Yet he did not publish the findings until 28 years later in an oral presentation in 1787, and it was only published in written form in 1789! Thereafter, for many years the condition was also known as Bayford syndrome 1,6,7.

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

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