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| IMAGE QUIZ |
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| Year : 2017 | Volume
: 5
| Issue : 1 | Page : 83-87 |
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Unusual cause of dysphagia
Yasser M Aljehani, Yasser El-Ghoneimy
Department of Surgery, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| Date of Web Publication | 16-Nov-2016 |
Correspondence Address:
Yasser M Aljehani
Department of Surgery, King Fahd Hospital of the University, University of Dammam, Dammam
Saudi Arabia
 DOI: 10.4103/1658-631X.194247 PMID: 30787763 
How to cite this article:
Aljehani YM, El-Ghoneimy Y. Unusual cause of dysphagia. Saudi J Med Med Sci 2017;5:83-7 |
This is a case of a 59-year-old woman who presented to the thoracic surgery clinic with dysphagia for several months. She is not known to have any medical illness. Her dysphagia started gradually for solids progressing to liquids over a period of several months. There were no constitutional symptoms over this period. Her surgical history was not contributory. Her physical examination was grossly unremarkable. The workup of her dysphagia was initiated; her laboratory investigations were within normal limits. The initial chest X-ray did not reveal a gross abnormality. Esophagogastroduodenoscopy showed evidence of external compression at the junction between the upper and mid-esophagus. Gastrografin study demonstrated an external compression of the esophagus [Figure 1]; computed tomography (CT) of the chest is shown in [Figure 2]a and [Figure 2]b. | Figure 1: Gastrografin study demonstrating the external esophageal compression
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 | Figure 2: (a) Axial computed tomography cut demonstrating the origin of the aberrant right subclavian artery. (b) Sagittal computed tomography reconstruction demonstrating the posterior course of the aberrant right subclavian artery and its subsequent esophageal external compression
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| Questions | |  |
- What is the abnormality seen on the chest CT scan?
- What is the possible embryological basis of such pathology?
- What are the general principles of management?
 View Answer
| Answers | | |
See the answer in page 87. | Answers | | |
- Right aberrant subclavian artery.
- Abnormal embryological development of the fourth aortic arch.
- The most important factors are the severity of symptoms and the fitness of patient to undergo surgical intervention if indicated.
| Discussion | | |
This is a case of dysphagia lusoria, resulted by a compression of the esophagus by a vascular structure. It was first described by Bayford in 1794. [1],[2] Any vasculature in the chest can be involved, but the most common is the aberrant right subclavian artery. The incidence is around 0.5%–1.8%. [2] Abnormal embryological development of the fourth aortic arch results in the development of a right aberrant subclavian artery. [3] In 80% of the cases, it crosses between the esophagus and the vertebral column; in 15%, between the esophagus and the trachea; and in 5%, passes anterior to the trachea. [1] The management depends on the severity of symptoms. Mild forms can be treated conservatively by dietary modifications and medications. Failure of conservative management or severe symptoms dictate surgical intervention provided, the patient is fit for surgery. The surgical option depends on the involved vascular structure and the expertise of the surgeon. [4]
| References | | |
| 1. | Asherson N. David Bayford. His syndrome and sign of dysphagia lusoria. Ann R Coll Surg Eng 1979;61-67.  |
| 2. | Levitt B, Richter JE. Dysphagia lusoria: A comprehensive review. Dis Esophagus 2007;20:455-60. |
| 3. | Panebianco V, Anzidei M, Catalano C, Passariello R. Dysphagia lusoria in combination with multiple congenital anomalies of the aortic arch. Eur J Cardiothorac Surg 2006;29:105. |
| 4. | Ota T, Okada K, Takanashi S, Yamamoto S, Okita Y. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg 2006;131:574-8. |
[Figure 1], [Figure 2]
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