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Dysphagia Lusoria in the Adult

Clinical Findings and Diagnostic Approach


Denysenko, Lex, B.A.; Levine, Marc S., M.D.; Lichtenstein, Gary R., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S44–S45
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS

School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Gastrointestinal Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA and Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

Purpose: Derived from the Latin lusus naturae and first described by Bayford in 1794, dysphagia lusoria (DL) can arise from any aortic arch anomaly compressing the esophagus, and the most common of these is the aberrant right subclavian artery (ARSA). A majority of cases present in infancy and are treated with surgery. DL first presenting in adulthood is exceedingly rare and not well characterized. Small case reports have described adult-onset DL in patients who were treated nonsurgically. We report our experience, and discus the importance of performing video cine esophagography in the setting of a patient with dysphagia and an unrevealing esophagogastroduodenoscopy (EGD).

Methods: A computer-generated search of the radiology records of a tertiary care hospital center was performed (keywords: aberrant or anomalous and subclavian) for the period of 1996–2005. IRB approval was obtained for this study. The results were screened for confirmation of the vascular anomaly and for dysphagia. Cases for which the dysphagia could be attributed to other pathology were not included in our analysis. Clinical information, including age at diagnosis, duration of symptoms, prior studies, and treatments was gathered by chart review and patient follow-up.

Results: Lusorian arteries were found in a total of 193 patients who underwent barium swallow or computed tomography (CT) of the chest. DL not attributable to any other cause was identified in 28 cases. 26 had an ARSA, one had an aberrant left subclavian artery, and one had a right-sided aortic arch. Mean age at diagnosis was 51 yrs (range 25–75 yrs). 25 were female. 17 patients reported dyspepsia in addition to dysphagia. The imaging modality that first yielded diagnosis was barium swallow (n = 19), CT (n = 8) or magnetic resonance imaging (n = 1). An extrinsic mass compressing on the esophagus was found in only 2 of 13 cases evaluated by EGD.

Conclusions: DL can present in adulthood, and cases not severe enough to warrant surgery often go unrecognized for years. When episodic solid food dysphagia is present in the setting of an unremarkable EGD, radiographic imaging is merited to help explain the etiology. A CT and / or barium swallow might be considered in these cases to help explain the etiology of the dysphagia.

© The American College of Gastroenterology 2005. All Rights Reserved.