臨牀消化器内科 Vol.13 No.4(1)


特集名 知っておくべき疾患 --食道
題名 Dysphagia Lusoria
発刊年月 1998年 04月
著者 諸国 眞太朗 岡山第一病院外科
【 要旨 】 1787年にBayfordは嚥下障害による栄養障害で死亡した患者の病理解剖を行い,嚥下困難は右鎖骨下動脈が大動脈弓から最後に分枝し食道を圧迫していたためと報告し,dysphagia lusoriaと名付けた.現在では大動脈弓,その主分枝の先天的異常で食道が圧迫され嚥下障害を呈す症候群として用いられる.異常血管による症状発現は少なく,また成人発症例が多い.これは異常血管の動脈硬化性病変および気管の弾性低下のためと考えられている.診断は本疾患を念頭におき,胸部X線,食道造影,血管造影,CTやMRIを用いる.治療は症状が軽ければ食事療法,症状が進行性で栄養障害が認められた場合にそれぞれの原疾患にあった手術を行う.
Theme Digestive Diseases to Know -- Esophagus
Title Dysphagia Lusoria
Author Shintaro Shokoku Surgery, Okayama Daiichi Hospital
[ 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.
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