The

n e w e ng l a n d j o u r na l

of

m e dic i n e

Images in Clinical Medicine

Lindsey R. Baden, M.D., Editor

Dysphagia Lusoria
B

Bartosz Hudzik, M.D., Ph.D.

Silesian Center for Heart Disease
Zabrze, Poland
bartekh@mp.pl

Mariusz Gsior, M.D., Ph.D.

Medical University of Silesia
Katowice, Poland

46-year-old otherwise healthy man presented with a 1-year history of occasional dysphagia to solid foods that was not accompanied by
weight loss. The results of a physical examination were unremarkable. A
barium-swallow examination revealed posterior oblique indentation of the proximal
esophagus (arrow in Panel A and Panel B; T indicates the trachea in Panel B). A computed tomographic scan of the chest with contrast enhancement showed an aberrant
right subclavian artery (Panel B, arrowheads; also indicated by arrows in Panel C, a
three-dimensional reconstruction) originating as the third branch of the aortic arch,
distal to the truncus bicaroticus (a vascular anomaly in which the carotid arteries
have a common origin) (Panel C, asterisk) and to the left subclavian artery. The
aberrant right subclavian artery followed a retroesophageal course, resulting in a
prominent compression of the esophagus, a finding consistent with dysphagia lusoria. The patient was referred to a vascular surgeon; because the dysphagia was only
mild to moderate, the patient declined surgery and was therefore treated conservatively with lifestyle modification. Most patients with an aberrant subclavian artery
are asymptomatic. Children may present with recurrent pulmonary infections or
stridor, in contrast to adults, who more often present with dysphagia. The onset of
symptoms in adulthood, as in this case, is relatively rare.

DOI: 10.1056/NEJMicm1600874
Copyright 2016 Massachusetts Medical Society.

e4

n engl j med 375;4

nejm.org

July 28, 2016

The New England Journal of Medicine

Downloaded from nejm.org on January 26, 2017. For personal use only. No other uses without permission.
Copyright 2016 Massachusetts Medical Society. All rights reserved.