Aberrant right subclavian artery – a rare congenital anatomical variation causing dysphagia lusoria
Abstract
Summary: An aberrant right subclavian artery (ARSA) is a rare anatomical variation of the aortic arch. Although an incidental finding and asymptomatic in the majority of individuals, an ARSA can cause troubling symptoms during both childhood and in later life. In adulthood, the most common symptom is dysphagia, where the condition is named dysphagia lusoria. In other rare cases it can cause shortness of breath, chronic cough and hoarseness of voice amongst others. We present a case of a 65-year-old female patient who was diagnosed with dysphagia lusoria following a barium swallow examination to investigate a 10-year history of dysphagia. She was further investigated with other imaging modalities to establish her diagnosis. The dysphagia was not progressive, nor did it result in malnutrition, and hence the patient was managed conservatively. There is currently no established guideline to classify the severity of symptoms or radiological findings of this anatomical anomaly. Our case reiterates the importance of such protocols, in order to be able to avoid the risks of an unnecessary surgical procedure, whilst being sure to prevent the undertreatment of affected individuals.
References
1 A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch. J Vasc Surg. 2018;68(1):298–306.
2 . Dysphagia lusoria: a comprehensive review. Dis Esophagus. 2007;20(6):455–60.
3 . Variations in the arrangement of the branches arising from the aortic arch in American Whites and Negroes. Anat Rec. 1932;54(2):247–51.
4 . The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations – a systematic study of 141 reports. Sci World J. 2014;2014:292734.
5 . Retrotracheal aberrant right subclavian artery: congenital anomaly or postsurgical complication? Glob Pediatr Health. 2018;5:2333794X18762689.
6 . A functional outcome swallowing scale for staging oropharyngeal dysphagia. Dig Dis. 1999;17(4):230–4.
7 , An account of singular case of obstructed deglutition. In: Memoirs of the Medical Society of London, instituted in the year 1773, Vol II. London: Fry H for Dilly C; 1789. pp. 251–282.
8 Prenatal diagnosis of aberrant right subclavian artery in an unselected population. Ultrasonography. 2017;36(3):278–83.
9 . Arteria lusoria: An anomalous finding during right transradial coronary intervention. Case Rep Cardiol. 2016;2016:8079856.
10 Prediction of nonrecurrent laryngeal nerve before thyroid surgery–experience with 1825 cases. J Surg Res. 2014;189(1):75–80.
11 . Aberrant right subclavian artery: a life-threatening anomaly that should be considered during esophagectomy. J Surg Tech Case Rep. 2014;6(2):61–3.
12 . Dysphagia lusoria as a differential diagnosis in intermittent dysphagia. Gastroenterol Hepatol. 2017;40(5):354–6.
13 Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg. 2014;48(5):521–6.
14 . You are never too old for a congenital disease! J Community Hosp Intern Med Perspect. 2013;3(3–4):22091.
15 Dysphagia lusoria: clinical aspects, manometric findings, diagnosis, and therapy. Am J Gastroenterol. 2000;95(6):1411–6.