University of California San Francisco San Francisco, CA, United States
Alexis M. Bayudan, MD1, Erin S. Keyes, MD1, Sara Lewin, MD2 1University of California San Francisco, San Francisco, CA; 2University of San Francisco, San Francisco, CA
Introduction: This is a case of a 51-year-old woman with a history of endometriosis and GERD, who presented with several months of progressive dysphagia.
Case Description/Methods: Three months prior to presentation, the patient noted a "scratching" sensation in her throat with swallowing. This progressed to dysphagia, described as a sensation of food and liquids "pooling" in her throat and chest after eating, associated with odynophagia, described as “someone stepping on my chest” with swallowing, choking with eating, and intermittent regurgitation and vomiting of both solids and liquids. One week prior to presentation, symptoms rapidly progressed. She was unable to take solids or liquids by mouth without severe dysphagia and vomiting and noted difficulty with swallowing her secretions. She denied weight loss, fevers, chills, hematemesis, melena, hematochezia, abdominal pain, diarrhea, constipation, cough, or shortness of breath. She reported a family history of gastric cancer. She had been taking daily omeprazole for the past year for intermittent reflux symptoms.
She presented to the emergency department for evaluation. Physical exam was unremarkable. Laboratory evaluation demonstrated normal complete blood count, creatinine, and lactate. The inpatient gastroenterology team was consulted, and performed an EGD. The endoscope easily traversed through the esophagus, which showed no evidence of intrinsic narrowing or obstruction. At 20 cm from the incisors, the esophagus was noted to have possible extrinsic compression from an external pulsating vessel.
A CT neck with contrast was obtained, which was notable for a retroesophageal aberrant right subclavian artery. A fluoroscopic swallowing evaluation also noted an impression on the posterior esophagus at the level of the upper thoracic spine.
A diagnosis of dysphagia lusoria was made and on hospital day #3, the vascular surgery team performed a right subclavian to carotid artery transposition surgery. Post-operatively she was noted to have complete resolution of her dysphagia and was tolerating a full regular diet by the day of discharge 3 days later. At her one-month post-operative appointment, she noted complete resolution of her dysphagia.
Discussion: Dysphagia lusoria is a rare condition characterized as dysphagia caused by an aberrant subclavian artery. Management varies from lifestyle changes in patients with mild symptoms to surgery to remove the aberrant vessel in severe cases as seen in our patient.
Disclosures: Alexis Bayudan indicated no relevant financial relationships. Erin Keyes indicated no relevant financial relationships. Sara Lewin indicated no relevant financial relationships.
Alexis M. Bayudan, MD1, Erin S. Keyes, MD1, Sara Lewin, MD2. P2791 - An Aberrant Cause of Dysphagia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.