| [ Summary ] |
In 1787, Bayford described a woman who eventually died of malnutrition after progressive dysphagia. At autopsy, he found esophageal compression by an anomalous right subclavian artery passing aberrantly from the left aortic arch between the trachea and the esophagus-causing the woman's dysphagia, and named it "dysphagia lusoria". Since then this term has been used to collectively refer to all aortic root anomalies causing esophageal dysphagia. Anomalies of the aortic arch are relatively common and the right aberrant subclavian artery "arteria lusoria" is the most common of these congenital vascular anomalies. It arises as the fourth branch of the aortic arch. The majority of patients having this anomaly remain asymptomatic throughout their lifetime. However, infrequently, an adult presents with esophageal dysfunction secondary to this vascular anomaly. The mechanism of esophageal compression in adults is suggested to involve the trachea becoming more rigid and the aberrant vessel becomes less compliant because of arteriosclerosis and dilatation or aneurysm formation. Awareness of this uncommon entity in adults may facilitate proper diagnosis with chest radiography, barium esophagraphy, angiography, CT, and MRI. Management of dysphagia lusoria is dependent upon the severity of symptoms. Dietary modifications may be successful in patients with mild symptoms. Surgical intervention is reserved for patients with progressive and prominent symptoms. |