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• W2922019169 abstract "Dysphagia lusoria or lusus naturae (freak of nature) occurs when the esophagus is extrinsically compressed by a vascular structure typically an aberrant right subclavian artery (ARSA). Most typically asymptomatic, this anatomic variation could rarely present with dysphagia or chest pain. Esophageal food impaction is however an unfamiliar manifestation of this condition, and to our knowledge, this is the 2nd case to be reported in the english literature. 49 year-old female patient presents with an acute feeling of food stuck in her chest following consumption of a meat-containing meal. She recalls a few months history of progressive solid food dysphagia and weight loss. Past medical history was significant for migraine. Physical examination and laboratory tests were unrevealing. A neck/chest contrast computed tomography (CT) scan showed a foreign body within esophagus at T1-T2 level where an ARSA was noted to cause a moderate narrowing of the esophageal lumen (Fig. 1). No mediastinal gas, masses or effusions were noted. An esophagogastroduodenoscopy revealed a food bolus impacted at the level of the ARSA in proximal esophagus (Fig. 2) which was successfully mobilized to stomach by gentle manipulation. Patient therefore received education to eat small bites and chew carefully.1774_A Figure 1. Endoscopic view showing food impaction and narrowing of the esophageal lumen.1774_B Figure 2. Computed tomography scan, axial view, showing narrowing of the esophageal lumen (arrow).First described by Bayford in 1794, dysphagia lusoria is a rare manifestation of external esophageal compression by an ARSA. This embryologic abnormality is asymptomatic in 90% of patients. Rarely dysphagia, chest pain, bloating, cough or food impaction may occur. Average age of presentation is 48 years with notable worsening of symptoms with advancing age as vascular structures become more rigid. Diagnosis is usually suspected through endoscopic or radiologic findings. Endoscopy may show a pulsating mass or an extrinsic compression of the esophagus. Barium esophagogram can show a defect at the level of third and fourth vertebrae. CT scan, magnetic resonance and angiography remain the best diagnostic modalities. Management starts by excluding any coexisting esophageal disease. Treatment depends on the severity of symptoms. A conservative approach via dietary modifications is advised in mild to moderate dysphagia. If failed, and in severe cases, surgical referral is endorsed. In non-surgical candidates, endoscopic dilation may be considered. Patients with dysphagia lusoria are often misdiagnosed thus heightened awareness of this entity is advised to avoid delayed diagnosis and management.1774_C Figure 3. Computed tomography scan, coronal view, showing aberrant right subclavian artery (headarrow) and food impaction (arrow)." @default.
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• W2922019169 date "2018-10-01" @default.
• W2922019169 modified "2023-09-27" @default.
• W2922019169 title "A “Freak of Nature”… Revealed!" @default.
• W2922019169 doi "https://doi.org/10.14309/00000434-201810001-01774" @default.
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