Navigating the Unexpected: Dysphagia Lusoria Complicates Severe Pneumonia With Parapneumonic Effusion.

Managing pneumonia, especially when complicated by underlying anatomical anomalies, presents unique challenges that require a nuanced and multidisciplinary approach. Dysphagia lusoria, a rare vascular anomaly where the right subclavian artery originates aberrantly, can coexist with other thoracic conditions, complicating both diagnosis and treatment. Understanding the interplay between such anomalies and common infections like pneumonia is crucial for optimal patient outcomes. This case report describes a 33-year-old male with a history of recurrent pneumonia in the past who presented to the emergency department (ED) with right flank pain and dyspnea persisting for one week. Initial investigations revealed moderate parapneumonic pleural effusion and right lower lobe pneumonia. At the time, an aberrant origin of the right subclavian artery (ARSA) (dysphagia lusoria) was incidentally detected on imaging. The patient's management included antibiotic therapy tailored for pneumonia and the placement of a chest tube for pleural effusion drainage. Despite intermittent dysphagia, surgical intervention for dysphagia lusoria was deferred due to its minimal impact on daily functioning. The patient improved significantly with supportive care and antibiotics, highlighting the complexity of managing pneumonia complicated by anatomical anomalies. This case underscores the importance of multidisciplinary management and tailored treatment strategies in addressing intricate clinical scenarios.

Technical considerations in robotic aberrant right subclavian artery resection for dysphagia lusoria.

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection. We describe the innovative technique and outcomes for two patients who successfully underwent robotic-assisted transthoracic resection of an ARSA after right carotid-subclavian bypass for dysphagia lusoria. Both patients experienced improvement or resolution of their dysphagia and no major complications. In select patients with a noncalcified origin of the ARSA without aneurysmal degeneration, the robotic-assisted approach represents a viable option.

Hybrid Management of Dysphagia Lusoria with Tevar Implantation and Bilateral Subclavian Arteries Debranching: A Review of the Literature and a Case Report.

Aberrant right subclavian artery (ARSA) causing dysphagia, the so-called "dysphagia lusoria", is a frequent embryologic anomaly of the aortic arch. In symptomatic patients, studies report several management options including surgical, hybrid, and totally endovascular strategies. Hybrid techniques have the advantage of no chest opening with reduced morbidity, but the problem of the ARSA stump causing recurrent or persistent dysphagia remains challenging in some cases. We conducted a literature review on the management strategies of ARSA and presented the case of a 72-year-old female patient with ARSA and dysphagia managed with thoracic endovascular repair of the aorta (TEVAR) and bilateral carotid-subclavian artery bypass. This technique was chosen because of the severe calcifications at the level of ARSA origin that would make surgical ligation difficult, or if an occluder device not suitable. We think that a patient-tailored approach should be considered in cases of dysphagia lusoria, considering that a multitude of strategies are reported.

Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature.

BACKGROUND: The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients. MATERIALS AND METHODS: We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery. RESULTS: Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges. CONCLUSIONS: ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.

Hematemesis on an esophageal foreign body revealing a double aortic arch: a case study.

A double aortic arch is a rare abnormality of the aortic arch caused by the persistence of the distal part of the right dorsal aorta. It can be manifested by respiratory and/or digestive symptoms. We report a case of double aortic arch revealed by an esophageal foreign body complicated by haematemesis in a 13-year-old boy having required multidisciplinary care.

Dysphagia lusoria in a young patient with a concomitant aortic arch anomaly, successfully treated with surgery: a case report.

Dysphagia is a common condition in clinical practice; however, an unusual type of dysphagia due to compression of the esophagus by an abnormal right subclavian artery may be discovered in a rare subset of patients. The prognosis and treatment will depend on the severity of the symptoms and the compromise of surrounding structures. We present the case of an 18-year-old female who presented with gradually progressive dysphagia. At first, it was treated as gastroesophageal reflux disease; nonetheless, the dysphagia became severe, and after a thorough evaluation, an aberrant right subclavian artery that compressed the esophagus was discovered along with a truncus bicaroticus. She was successfully treated with surgery without any complications. On follow-ups, she's doing well.

Incomplete vascular ring of the aortic arch presenting with dysphagia in an adult: case report.

Anomalies of the arterial branches of the arch of the aorta are rare, with the aberrant right subclavian artery being the most common of this anomaly. Majority of the anomalies are asymptomatic and often discovered as incidental findings. In the great majority of the symptomatic cases, the presentation may be either with breathlessness or dysphagia or both. This is in addition to the nature of the intrinsic arterial disease of the aberrant vessel, especially in adult patients; and unless borne in mind, the diagnosis is often missed leading to delays and wrong treatment. In this report we present a case of dysphagia in an adult male Nigerian initially diagnosed as œsophageal stricture from herbal potion ingestion but review of his imaging investigations gave a final diagnosis of dysphagia lusoria from an aberrant right subclavian artery. The difficulty in making a diagnosis and the need for a multidisciplinary review of the imaging investigations are highlighted. The patient was successfully treated by a combined trans-thoracic and cervical approach with division and re-implantation of the aberrant vessel unto the right common carotid artery. He has remained symptom-free for 2 years after surgery. Although the great majority of these anomalies are often asymptomatic, it is important they are borne in mind both in imaging investigations as well as in procedures involving structures in the upper visceral mediastinum. Various surgical approaches have been documented in the management of symptomatic ones; it is however recommended that options that ensure revascularization of the affected limb be selected.

Surgical repair of severe dysphagia lusoria.

This case report describes a case of severe dysphagia lusoria secondary to an aberrant right subclavian artery causing compression of the esophagus. Our 62-year-old female patient presented with severe dysphagia and underwent right carotid-subclavian bypass with uncovered thoracic endovascular aortic repair and coil embolization of the aberrant right subclavian artery. This case is unique in that an uncovered dissection stent graft was used to avoid occluding the anatomic left subclavian artery and, therefore, avoid a left carotid-subclavian bypass. This case highlights a unique anatomic variant, its surgical repair, and the long-term improvement in the patient's quality of life.

Dysphagia With Unusual Etiology: A Case Report.

Here, we present a case of dysphagia with a very unusual etiology. Dysphagia is a symptom of concern and can occur secondary to multiple etiologies. Therefore, prompt and appropriate evaluation is necessary, as treatment varies depending on the underlying cause. Our patient was a 73-year-old female admitted for dysphagia associated with recent significant weight loss and a history of long-term smoking. A CT scan of her neck revealed a mass that was compressing the esophagus, but the etiology of the mass was unexpected. This case highlights the importance of considering rare causes of dysphagia and underscores the need for physicians to be aware of them.

Arteria Lusoria as a Cause of Dysphagia in an Infant.

The aberrant right subclavian artery (i.e., arteria lusoria) arising from the left part of the aortic arch is a rare congenital anomaly. In some patients, esophageal compression may cause symptoms of dysphagia, also called dysphagia lusoria. It can cause serious feeding disorders and poor weight gain in young children. We present the case of an early onset of dysphagia lusoria in a 1-month-old girl whose clinical diagnosis was confirmed by esophagography and magnetic resonance imaging. This kind of vascular anomaly can present a diagnostic challenge and should be considered in diagnosing dysphagia in childhood.

A Truncus Bicaroticus and an Aberrant Right Subclavian Artery. A Rare Case and Literature Review / Un Tronco Bicarótico y una Arteria Subclavia Derecha Aberrante. Un Caso Raro y Revisión de la Literatura

SUMMARY: An aberrant right subclavian artery described by David Bayford, is rare and one of the aortic arch anomalies. It gives usually incidental findings. We present the case of a 57-year-old woman who was admitted to a neurology outpatient clinic due to a headache and no obvious pathology was detected during a physical examination. In consequence of the brain and chest CT angiography, incidental anomalies of the aortic arch branches were found and asymptomatic aberrant right subclavian artery and bicarotid trunk was diagnosed. The presence of this anomaly is becoming increasingly important in avoiding vascular injuries and cerebral complications in patients undergoing endovascular intervention on the aorta aortic arch surgery, thyroidectomy, or cervicothoracic surgery. So, detailed knowledge of variations of the subclavian artery and bicarotid trunk is paramount for radiologists and surgeons operating on the region of the anterior neck.

Una arteria subclavia derecha aberrante descrita por David Bayford, es rara y es una de las anomalías del arco aórtico. Además, suele ser hallazgos accidentales. Presentamos el caso de una mujer de 57 años que ingresó a una consulta de neurología por dolor de cabeza, sin embargo, no se le detectó patología evidente al examen físico. En el angio-TC de cerebro y tórax, se encontraron anomalías incidentales de las ramas del arco aórtico y se diagnosticó arteria subclavia derecha aberrante asintomática y tronco bicarotídeo. Determinar la presencia de esta anomalía es cada vez más importante, para así evitar lesiones vasculares y complicaciones cerebrales en pacientes sometidos a intervención endovascular de la aorta, cirugía del arco aórtico, tiroidectomía o cirugía cervicotorácica. Por lo tanto, el conocimiento detallado de las variaciones de la arteria subclavia y el tronco bicarotídeo es primordial para los radiólogos y cirujanos que operan en la región anterior del cuello.

Navigating the Esophageal Enigma: A Vascular Odyssey of Dysphagia.

We report a 58-year-old female with severe throat pain, difficulty swallowing, choking on solid meals, coughing, and hoarseness. CT angiography of the chest revealed vascular compression of the esophagus by an aberrant right subclavian artery (ARSA). The patient underwent thoracic endovascular aortic repair (TEVAR) and revascularization to address the ARSA. The patient experienced significant improvement in her symptoms following the surgical intervention.  Dysphagia lusoria is a rare condition involving compression of the esophagus and airway by an ARSA. While medical management is the first line of treatment for mild symptoms, surgical intervention is often necessary for severe cases or those unresponsive to conservative management. TEVAR with revascularization is a feasible and minimally invasive option for treating symptomatic non-aneurysmal ARSA, potentially resulting in favorable outcomes.

Right Subclavian Artery With Kommerell's Diverticulum: A Rare Cause of Dysphagia.

Kommerell's diverticulum is an embryologic developmental anomaly of the aortic arch wherein a diverticulum arises from either the left or the right aortic arch. It results due to the persistence of the remnant of the fourth dorsal aortic arch. We present a case of a 66-year-old female presenting with complaints of throat pain and difficulty swallowing. A computed tomography (CT) scan of the neck with contrast revealed an incidental finding of an aberrant right subclavian artery with associated diverticula of Kommerell, measuring up to 1 cm, causing a mass effect on the esophagus and posterior trachea. A diagnosis of dysphagia lusoria was established, and an upper gastrointestinal (GI) series revealed narrowing of the esophagus from posterior extrinsic compression. The patient was discharged home for nutrition optimization with a percutaneous endoscopic gastrostomy (PEG) tube due to significant weight loss from the inability to swallow before proceeding with surgery to repair the aberrant right subclavian artery.

Non-Recurrent Laryngeal Nerve: A Rare Anatomical Entity in a Patient Undergoing Hemithyroidectomy.

A non-recurrent laryngeal nerve (NRLN) is a common anatomical modification with an occurrence rate ranging from 0.5% to 0.7% in surgical procedures related to thyroid pathology [1]. In this condition cervical vagus nerve reaches the larynx directly, increasing the likelihood of vocal cord palsy. Non-RLN injury can be reduced by anticipating it and identifying it early. This case report describes how a non-recurrent inferior laryngeal nerve was discovered intraoperatively during systemic dissection, averting intra-operative nerve injury. A 40-year-old female reported to the department of Otorhinolaryngology and Head and Neck Surgery Outpatient Clinic for a nodular tumor in her neck that has been increasing for the previous five years. The colloid multi-nodular thyroid of the right lobe was confirmed by a fine needle aspiration cytology (FNAC). The patient was lined up for a surgical procedure requiring resection of the right lobe of the thyroid. A non-recurrent right inferior laryngeal nerve was discovered during surgery. The operation and recovery went smoothly, and there was no change in his voice in subsequent follow-ups. For those who are related to this professional line, this presentation provides a summary of what a non-recurrent laryngeal nerve looks like during surgery. This is critical for anyone undergoing diagnostic and surgical procedures which demand to be invasive in the region involving the neck and upper thorax, as it lowers the risk of iatrogenic nerve injury. A solitary trauma of this nerve can induce irreversible hoarseness, whereas a multilateral lesion might result in aphonia and potentially deadly dysphonia.

Dysphagia Lusoria Causing Aspiration Pneumonitis in a Patient With Recurrent Pancreatitis.

Dysphagia lusoria (DL) occurs due to an aberrant right subclavian artery (ARSA) compressing the esophagus resulting in dysphagia, odynophagia, and/or reflux symptoms. It is diagnosed by barium esophagram followed by a CT scan or MRI. In this case report, there is a 44-year-old male with a chronic history of reflux and a cough that presents after a meal. The case was complicated due to the history of the patient's alcoholism with recurrent pancreatitis. A CT scan was obtained during his admission, which showed pleural effusion, atelectasis, aspiration pneumonia, and an incidental aberrant RCA. Although DL is a rare pathology, 60%-80% of patients remain asymptomatic, and patients with symptoms can be managed conservatively or surgically, depending on their severity.

Dysphagia lusoria in a young woman with chest pain.

Patients with dysphagia often have an esophageal disorder. This case report describes a patient with persistent dysphagia and chest pain who had a normal esophagogastroduodenoscopy. Computed tomography of the chest with contrast revealed an aberrant right subclavian artery compressing the esophagus. A vascular procedure was performed and corrected the dysphagia. This case demonstrates that aberrant vessels can occasionally cause dysphagia.

Two Patients With Difficulty in Swallowing due to Dysphagia Lusoria.

Dysphagia lusoria (DL) is a rare clinical entity caused by compression of the esophagus by an aberrant right subclavian artery. It is coined from the Latin word meaning freak or jest of nature, with an estimated prevalence of approximately 0.5%. Before the term DL was known, the artery abnormality was referred to as luxus nature. Most patients are asymptomatic. In 30-40% of cases, DL results in tracheoesophageal symptoms like dysphagia to solid foods, chest pain, cough, and Horner's syndrome. Symptoms presenting later in life have been linked to arteriosclerosis and diminishing esophageal compliance resulting in compression. Another reason why people become symptomatic is due to Kommerell's diverticulum, a disorder that was first described by Kommerell, a German radiologist in 1936. It is also known as lusoria diverticulum, remnant diverticulum or lusoria root. This disorder represents a remnant of the left dorsal arch which forms a vascular ring behind the esophagus, leading to external compression. The key to diagnosis of DL is a barium esophagogram which may show extrinsic compression. Computed tomography or magnetic resonance imaging can be used for definite delineation of the vascular anatomy. Treatment approach is dietary modification or surgical intervention for unresponsive cases. Here, we present cases of dysphagia in two middle-aged women caused by compression effect on the esophagus by an aberrant right subclavian artery who did not respond to dietary modification.

Aberrant Right Subclavian Artery Causing Dysphagia: A Case Report of Dysphagia Lusoria.

Dysphagia lusoria is a rare condition, with a prevalence of less than 1%, that occurs through secondary compression of the esophagus posteriorly by an aberrant right subclavian artery. It commonly presents with dysphagia to solids. Management is usually done with dietary modification; however, more severe and intractable cases may require surgical intervention. We describe this rare vascular anomaly in a 54-year-old female presenting with mechanical dysphagia.

The hardest pill to swallow: A freak of nature.

Not required.

Systematic Review and Meta-Analysis of Outcomes After Operative Treatment of Aberrant Subclavian Artery Pathologies and Suggested Reporting Items.

OBJECTIVE: To synthesise and present all available evidence regarding the surgical treatment of patients with aberrant subclavian artery (aSA) pathologies during the last 30 years. The study also aimed to create a checklist of suggested reporting items to help increase reporting homogeneity. METHODS: A systematic search of medical databases was performed to identify all studies published between 1990 and 2020 reporting on the outcomes of patients undergoing surgery for an aSA pathology. Patients were divided into two groups; Group A included patients undergoing open or hybrid surgery through sternotomy/thoracotomy and Group B included patients undergoing endovascular or hybrid treatment without chest access. The % crude rates (CR) of all variables of interest were calculated. A proportion meta-analysis was performed reporting pooled rates with 95% confidence intervals (CIs). RESULTS: Three hundred and fourteen studies were identified reporting on the surgical outcomes of 732 patients (60.1% males; 440/732). The quality of evidence was generally low, with 286 studies including fewer than four patients and 28 studies with five or more cases. Aberrant right subclavian artery (aRSA) in a left sided aortic arch was present in 71.4% of the patients and a Kommerell's diverticulum was present in 50.1% of the cases. A total of 68% of the patients were symptomatic on presentation, with the majority complaining of dysphagia (49.6%). Group A included 453 and Group B 279 patients. Studies reporting on five or more patients were included in the main meta-analysis. The pooled early mortality rate was 1.62% (95% CI 0.05% - 4.53%) in Group A and 1.96% (95% CI 0 - 6.34%) in Group B. Pooled rates of symptom relief were 99.52% (95% CI 92.05% - 100.00%) in Group A and 95.79% (95% CI 83.96% - 100.00%) in Group B. CONCLUSION: The surgical techniques used to treat aSA and aortic pathologies involving an aSA had remarkably low mortality rates and high clinical success, regardless of the technique used.