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• W2000267990 abstract "Question: An 87-year-old woman presented to her cardiologist with a 4-week history of dysphagia and a 20-pound weight loss. Three years previously, she developed a 4-cm Stanford type B descending thoracic aorta aneurysm. She also had hypertension and vertebral compression fractures. Vitals and physical examination were normal. Hemoglobin, electrolytes, and calcium levels were normal. A chest CT was ordered (Figure A). She underwent an esophagogastroduodenoscopy (Figure B). What is the diagnosis? What would the management be? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Dysphagia aortica is a condition where extrinsic compression of the esophagus occurs owing to an aneurysm or ectasia of the thoracic aorta. It is classically seen in elderly women with a history of hypertension and atherosclerotic aortic changes and kyphotic degenerative spine changes. The diagnosis of dysphagia aortica is difficult. A barium esophagram can suggest the diagnosis, but lateral and oblique views are necessary. Esophageal manometry may reveal a localized high-pressure barrier with disordered motility.1Wilkinson J.M. Euinton H.A. Smith L.F. et al.Diagnostic dilemmas in dysphagia aortica.Eur J Cardiothorac Surg. 1997; 11: 222-227Crossref PubMed Scopus (39) Google Scholar Endoscopy may show extrinsic compression of the esophagus and pulsations may be seen. The gold standard for diagnosis is computed tomographic angiography. Management of dysphagia aortica is limited mostly to dietary modifications such as liquefaction of food.2Hilliard A.A. Murali N.S. Keller A.S. Dysphagia aortica.Ann Intern Med. 2005; 142: 230-231Crossref PubMed Scopus (13) Google Scholar Esophageal dilation with bougies has been attempted in 1 case.1Wilkinson J.M. Euinton H.A. Smith L.F. et al.Diagnostic dilemmas in dysphagia aortica.Eur J Cardiothorac Surg. 1997; 11: 222-227Crossref PubMed Scopus (39) Google Scholar Occasionally, if the dysphagia is very severe and if the patient is a surgical candidate transposition of the distal esophagus, separation of the esophagus from the aorta and repair of the aneurysm may be undertaken. If the patients are not surgical candidates, insertion of a percutaneous gastrostomy tube is an option. Figure A shows compression of the esophagus by the atherosclerotic aneurysm of the descending aorta. Figure B shows extrinsic compression of the esophagus. Our patient was not felt to be a surgical candidate. Therefore, an esophageal self-expandable metal stent was placed. Initially, a fully covered stent was placed, but quickly migrated. It was removed and replaced with a partially uncovered stent (Figures C and D). Her dysphagia rapidly improved and she tolerated a full diet. This is the first report of esophageal stenting to treat dysphagia aortica." @default.
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• W2000267990 date "2009-11-01" @default.
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• W2000267990 title "Dysphagia and Weight Loss in an Elderly Person" @default.
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• W2000267990 doi "https://doi.org/10.1053/j.gastro.2009.02.011" @default.
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