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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318244a30b
Image of the Month

Cardiovascular Dysphagia

Semeraro, Laura; Lénaud, Anne-Valérie; McLin, Valérie A.

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Department of Pediatrics, Hôpitaux Universitaires de Geneve, Genève, Switzerland.

Address correspondence and reprint requests to Valérie A. McLin, MD, Hôpitaux Universitaires de Geneve, Genève 14, Switzerland (e-mail:

Received 25 November, 2011

Accepted 1 December, 2011

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A 14-year-old Senegalese patient with a history of rheumatic fever was admitted for mitral and aortic valve repair. She presented with anorexia, heartburn relieved by vomiting, and a 2-year history of postprandial emesis. Physical examination was remarkable for severe cachexia (body mass index 10.6 kg/m2), left thoracic protrusion, and 4/6 systolic murmur. An upper gastrointestinal series revealed a mass effect on the distal oesophagus, consistent with a cardiac compression. Chest x-ray confirmed cardiomegaly. The patient's symptoms resolved following valvular repair.

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Cardiovascular dysphagia (CD) secondary to congestive heart failure is traditionally diagnosed in elderly patients (1,2). Left atrial enlargement is an unusual cause of CD in pediatrics (3). In children, CD is rare and typically associated with developmental aortic arch anomalies (3). The abnormal oesophageal motility observed in CD develops secondary to extrinsic, pulsatile, cardiovascular compression (1,2). A fixed region of high pressure can induce mucosal injury and further exacerbate dysphagia (1,2).

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1. Gotsman I, Mogle P, Shapira MY. An unusual cause of dysphagia. Postgrad Med J 1999;75:629–31.

2. Capell MS. Endoscopic, radiographic, and manometric findings associated with cardiovascular dysphagia. Dig Dis Sci 1995;40:166–76.

3. Newman LA, Keckley C, Petersen MC, et al. Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatrics 2001;108:106.

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