An Unusual Dysphagia for Solids in a 17-Year-Old Girl Due To a Lusoria Artery: A Case Report and Review of the Literature

Abstract

Background: Dysphagia is a condition that can have many underlying causes, often different between adults and children and its early diagnosis is crucial especially during childhood and adolescence, given the importance of proper nutritional intake to ensure adequate growth and development. Case report: We described the case of a 17-year-old girl reporting dysphagia for solids for approximately one month. No symptoms were previously referred. Oesophagogastroduodenoscopy was performed, detecting an image of ab extrinseco compression at the level of the mid-cervical oesophagus. An upper gastrointestinal tract radiography confirmed an oesophageal impression above the arch of the aorta suggestive of vascular abnormality. Computed tomography angiography and three-dimensional reconstruction techniques showed the presence of a lusoria artery that originated from the medial margin of the descending aorta and crossed the trachea and oesophagus posteriorly to the distal third. The lusoria artery was transected via a left thoracotomy and re-implanted into the right common carotid artery with complete symptom resolution. Conclusions: Dysphagia lusoria is an impairment of swallowing due to compression from an aberrant right subclavian artery. The diagnosis is always difficult, as the symptoms are often nonspecific. It is imperative to accurately identify and properly manage dysphagia in pediatric age and this is only possible with an anamnestic, clinical and instrumental process that takes into account an adequate differential diagnosis.

Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10)

“…The result of external compression of aberrant right subclavian artery on the esophagus causes dysphagia, which is known as Dysphagia lusoria. Almost all of the cases reported in the literature have been shown to have dysphagia with solid foods in dysphagia lusoria [24,25]. Consequently, in the current study, PAICA was considered as a structural swallowing disorder because it causes dysphagia mostly in solid foods.…”

Beyond the Classic Causes of Dysphagia: Bayford-Autenrieth Dysphagia

“…Years later, in 1787, David Bayford first described DL in a female patient with a medical history of lifelong dysphagia [ 1 ]. The culprit artery follows a retroesophageal path in 80% of cases, 15% between the trachea and esophagus, and 5% anterior to the trachea [ 3 ]. In a typical scenario, three main vessels branch off the aortic arch: the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery.…”

Morphological Aspects of the Aberrant Right Subclavian Artery—A Systematic Review of the Literature

“…Surgical intervention should be considered in cases that show a significant decrease in the quality of life. Success depends on the malformation's morphological aspect, the associated pathology, and the skills of the operative team [74,75].…”