51-year-old female presents with dysphagia and odynophagia.
Barium Swallow in the RAO Projection
51-year-old female who presents with dysphagia and odynophagia. Barium swallow in the RAO projection, shows a bilobed extrinsic defect of the esophagus at the level of the aortic arch. (reversed 3 sign) The upstream (proximal) deformity is caused by the aorta, and the downstream deformity reflects the defect caused by the crossing aberrant right subclavian.
Courtesy Alexander Pankratov MD TheCommonVein.net 287Lu 136534c
Bilobed Extrinsic Defect in the Esophagus at the Level of the Arch
51-year-old female who presents with dysphagia and odynophagia. Barium swallow in the RAO projection, shows a bilobed extrinsic defect of the esophagus at the level of the aortic arch. (reversed 3 sign) The upstream (proximal) deformity is caused by the aorta, (b white arrowhead) and the downstream deformity reflects the defect caused by the crossing aberrant right subclavian artery (b, red arrowhead).
Courtesy Alexander Pankratov MD TheCommonVein.net 287Lu 136534cL
Correlation With Barium Pill Swallow
Transient Hold Up with Correlative Symptoms
51-year-old female who presents with dysphagia and odynophagia. Barium swallow in the LAO projection, shows an extrinsic defect of the esophagus at the level of the aortic arch (a,b red arrowheads) A barium pill gets stuck at this level (c, red arrowhead) and the patient complained of dysphagia and odynophagia. She was given a sip of barium and the pill (d, white arrowhead) passed through the obstruction (d red arrowhead). The odynophagia persisted
Alexander Pankratov MD TheCommonVein.net 287Lu 136535cL
Aberrant Right Subclavian Artery and Distended Esophagus
51-year-old female who presents with dysphagia and odynophagia.
CT of the chest in the axial projection (a), shows an aberrant right subclavian artery passing behind the esophagus (pink arrowhead) at the level of the aortic arch. Image b in the sagittal plane, shows the aberrant RSA (red arrowhead). In this projection the esophagus (pink arrowhead) is distended with fluid, likely as a result of the partial obstruction.
Image c in the coronal projection, shows the aberrant RSA (red arrowhead) crossing posteriorly from left to right, anterior to the spine
Alexander Pankratov MD TheCommonVein.net 287Lu 136544cL
Discussion
- Dysphagia Lusoria,
- caused by aberrant right subclavian artery (RSA). which
- originates as the last branch of the aortic arch and passing behind the esophagus.
- can lead to compression of the esophagus,
- causing dysphagia
- discomfort, and
- pain
- although congenital,
- symptoms may not appear until later in life.
- treatment options
- conservative management,
- dietary modifications, or
- surgery
- conservative management,