Abstract
Dysphagia lusoria is used to describe the dysphagia that develops due to the pressure of vascular structures to the esophagus posteriorly. The majority of cases are associated with the aberrant right subclavian artery. A 15-year-old male was admitted to hospital with complaints of dysphagia for one year and gastroesophageal reflux GER was considered. Reflux scintigraphy was performed, no abnormality was detected and no treatment was given. Subsequently, the patient, who had intermittent dysphagia, was admitted to the another center. He was treated with proton pump inhibitor PPI for 3 months. He benefited from this treatment during the period of treatment. However, the patient, who had not used the medication for three months, developed increasing complaints especially in the consumption of solid foods. The patient then presented and was admitted to our pediatric cardiology outpatient clinic where, upon echocardiography, no abnormality except right aortic arch was detected. The vascular ring was considered as a preliminary diagnosis. Right aortic arch anomaly and an aberrant left subclavian artery were diagnosed by computed tomography CT and three-dimensional contrast-enhanced CT angiography, and then he was referred to the gastroenterology outpatient clinic. Upon thorough evaluation of patient’s history, it was determined that he had complains of dysphagia particularly with solid food. His physical examination was normal except epigastric tenderness. The barium esophagram demonstrated the external indentation and mild left angulation posteriorly in the middle of the esophagus secondary to the aberrant left subclavian artery at the level of aortic arch. It was thought that this image may be sufficient to explain the difficulty in swallowing. Dietary modifications and PPI medication were given. At the 3-month follow up examination, no epigastric tenderness was noted nor any other complaints were received. We present a rare case with right aortic arch anomaly and dysphagia successfully treated with dietary modifications and medication
References
- Asherson N. David Bayford. His syndrome and sign of dysphagia lusoria. Ann R Coll Surg Engl 1979; 61: 63-7.
- Levitt B, Richter JE. Dysphagia lusoria: a comprehensive review. Dis Esophagus 2007; 20: 455-60. [CrossRef]
- Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. [CrossRef]
- Carrizo GJ, Marjani MA. Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 2004; 31: 168-71.
- Celikyay ZR, Koner AE, Celikyay F, Denız C, Acu B, Firat MM. Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging 2013; 37: 1011-9. [CrossRef]
- Shuford WH, Sybers RG, Gordon IJ, Baron MG, Carson GC. Circumflex retroesophageal right aortic arch simulating mediastinal tumor or dissecting aneurysm. Am J Roentgenol 1986; 146: 491-6. [CrossRef]
- Payne DN, Lincoln C, Bush A. Right sided aortic arch in children with persistent respiratory symptoms. BMJ 2000; 321: 687-8.
- Abraham V, Mathew A, Cherian V, Chandran S, Mathew G. Aberrant subclavian artery: anatomical curiosity or clinical entity. Int J Surg 2009; 7: 106-9. [CrossRef]
- Berdon WE. Rings, slings, other things: vascular compression of the infant trachea updated from the midcentury to the millennium-- the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology 2000; 216: 624-32. [CrossRef]
- Janssen M, Baggen MG, Veen HF, et al. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol 2000; 95: 1411-6. [CrossRef]
- Kersting-Sommerhoff BA, Sechtem UP, Fischer MR, Higgins CB. MR imaging of congenital anomalies of the aortic arch. AJR 1987;149:9- 13. [CrossRef]
- Bennett AL, Cock C, Heddle R, Morcom RK. Dysphagia lusoria: A late onset presentation. World J Gastroenterol 2013; 19: 2433-6. [CrossRef]
Abstract
Disfaji lusoria, özofagusa vasküler basıya bağlı olarak oluşan disfajiyi tanımlamak için kullanılır. Vakaların çoğunluğu aberran sağ subklavyen arter ile ilişkilidir. Bir yıldır yutma güçlüğü yakınması olan 15 yaşındaki hastaya ilk başvurduğu merkezde gastroözofageal reflü GÖR tanısı düşünülüp reflü sintigrafisi çekilmiş, anormallik saptanmamış ve hastaya herhangi bir tedavi verilmemiş. Daha sonra ara ara yutma güçlüğü yakınmaları olan hastaya başvurduğu başka bir merkezde 3 ay boyunca PPI ilaç tedavisi verilmiş, ilaç kullandığı dönemde yutma güçlüğü yakınmalarının azaldığı görülmüş. Ancak son üç aydır ilaç kullanmayan hastanın özellikle katı gıdalara karşı yutma güçlüğü artmış. Bunun üzerine hasta hastanemiz çocuk kardiyoloji polikliniğine başvurdu, ekokardiyografisinde sağ aortik ark dışında anormallik saptanmadı. Yutma güçlüğü açısından vasküler ring ön tanısı ile tetkik edildi. Bilgisayarlı tomografi BT ve üç boyutlu kontrastlı BT anjiografi tetkiklerinde sağ aortik ark anomalisi ve aberran sol subklavyen arter tespit edildi ve hasta gastroenteroloji polikliniğine yönlendirildi. Hastanın öyküsünden ağıza acı su gelme ve özellikle katı gıdalara karşı yutma güçlüğü yakınmaları olduğu öğrenildi. Fizik muayenesinde epigastrik hassasiyeti dışında özellik yoktu. Hastaya baryumlu özofagus grafisi çekildi; özofagus orta kesimde aortik ark seviyesinde retroözofageal seyirli sol subklavyen arterin oluşturduğu posteriorda dıştan basıya ait indentasyon ve hafif sola açılanma görüldü. Bu görünümün hastanın yutma güçlüğü problemini açıklayabileceği düşünüldü. Hastaya PPI ilaç tedavisi başlandı, diyet önerilerinde bulunuldu. Üç ay sonraki poliklinik kontrolünde yakınması olmayan hastanın fizik muayenesinde epigastrik hassasiyeti de yoktu. Aortik ark anomalisi ve yutma güçlüğü yakınması olan, diyet değişiklikleri ve ilaç tedavisi ile başarıyla tedavi edilen nadir bir vakayı sunuyoruz
References
- Asherson N. David Bayford. His syndrome and sign of dysphagia lusoria. Ann R Coll Surg Engl 1979; 61: 63-7.
- Levitt B, Richter JE. Dysphagia lusoria: a comprehensive review. Dis Esophagus 2007; 20: 455-60. [CrossRef]
- Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. [CrossRef]
- Carrizo GJ, Marjani MA. Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 2004; 31: 168-71.
- Celikyay ZR, Koner AE, Celikyay F, Denız C, Acu B, Firat MM. Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data. Clin Imaging 2013; 37: 1011-9. [CrossRef]
- Shuford WH, Sybers RG, Gordon IJ, Baron MG, Carson GC. Circumflex retroesophageal right aortic arch simulating mediastinal tumor or dissecting aneurysm. Am J Roentgenol 1986; 146: 491-6. [CrossRef]
- Payne DN, Lincoln C, Bush A. Right sided aortic arch in children with persistent respiratory symptoms. BMJ 2000; 321: 687-8.
- Abraham V, Mathew A, Cherian V, Chandran S, Mathew G. Aberrant subclavian artery: anatomical curiosity or clinical entity. Int J Surg 2009; 7: 106-9. [CrossRef]
- Berdon WE. Rings, slings, other things: vascular compression of the infant trachea updated from the midcentury to the millennium-- the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology 2000; 216: 624-32. [CrossRef]
- Janssen M, Baggen MG, Veen HF, et al. Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol 2000; 95: 1411-6. [CrossRef]
- Kersting-Sommerhoff BA, Sechtem UP, Fischer MR, Higgins CB. MR imaging of congenital anomalies of the aortic arch. AJR 1987;149:9- 13. [CrossRef]
- Bennett AL, Cock C, Heddle R, Morcom RK. Dysphagia lusoria: A late onset presentation. World J Gastroenterol 2013; 19: 2433-6. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | September 1, 2018 |
| Published in Issue | Year 2018Issue: 3 |