Dysphagia Lusoria: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr N Srikantiya Indira , Vascular Endovascular Surgeon

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Dysphagia Lusoria is a rare condition in which difficulty swallowing (dysphagia) is caused by compression of the esophagus by an abnormal blood vessel, most commonly an aberrant right subclavian artery. The condition is congenital but symptoms may not appear until adolescence or adulthood. Individuals may experience difficulty swallowing solid foods, chest discomfort, coughing, or choking while eating. Early diagnosis and appropriate treatment are important to relieve symptoms, prevent nutritional problems, and improve swallowing function.

What are the Symptoms of Dysphagia Lusoria?

Symptoms of dysphagia lusoria include difficulty swallowing, sensation of food sticking in the throat, chest discomfort, coughing, and sometimes weight loss.

Swallowing Difficulties

The hallmark symptom of dysphagia lusoria is difficulty swallowing, known as dysphagia. Patients may experience a sensation of food getting stuck in the throat or chest, which can lead to discomfort and even pain during meals.

Respiratory Symptoms

In certain cases, the compression of the esophagus can also affect the trachea, leading to respiratory symptoms such as coughing, wheezing, or shortness of breath. These symptoms can be particularly pronounced in infants and young children.

Additional Symptoms

Other potential symptoms include recurrent respiratory infections, due to food aspiration, and unexplained weight loss, stemming from inadequate nutritional intake.

What are the Causes of Dysphagia Lusoria?

Dysphagia lusoria is caused by an abnormal blood vessel, usually an aberrant right subclavian artery, that compresses the esophagus and interferes with swallowing.

Embryological Development

The primary cause of dysphagia lusoria is an embryological aberration. During fetal development, the normal regression of the fourth aortic arch fails to occur, resulting in an aberrant right subclavian artery. This artery takes an unusual path, often crossing behind the esophagus, leading to compression and subsequent dysphagia symptoms.

Aortic Arch Anomalies

In some cases, dysphagia lusoria is associated with other aortic arch anomalies. These include the presence of a Kommerell's diverticulum, an outpouching at the origin of the aberrant artery, which can exacerbate esophageal compression and dysphagia symptoms.

When to See a Doctor for Dysphagia Lusoria?

Individuals with persistent difficulty swallowing, unexplained weight loss, or recurrent choking episodes should consult a Gastroenterologist, Vascular Endovascular Surgeon or Cardiothoracic Surgeon for evaluation.

You should see a doctor if you experience:

Progressive difficulty swallowing solid foods
Food frequently becoming stuck while eating
Unexplained weight loss due to swallowing difficulties

Seek immediate medical attention if you:

Experience complete inability to swallow or food impaction
Develop choking, aspiration, or difficulty breathing while eating
Have severe chest pain or repeated aspiration pneumonia

These symptoms may indicate serious complications requiring urgent medical evaluation and treatment.

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How is Dysphagia Lusoria Diagnosed?

Dysphagia lusoria is diagnosed using imaging tests such as a barium swallow study, CT scan, or MRI to detect abnormal blood vessels compressing the esophagus.

Radiological Assessment

Radiology plays a crucial role in the diagnosis of dysphagia lusoria. A barium swallow test can reveal the characteristic indentation on the esophagus caused by the aberrant artery. However, more definitive imaging modalities, such as computed tomography (CT) angiography or magnetic resonance imaging (MRI), are often employed to visualize the vascular anomaly and assess its impact on surrounding structures.

Endoscopic Evaluation

Endoscopy may be utilized to rule out other potential causes of dysphagia and to assess the esophageal lining for any secondary damage or inflammation resulting from compression.

What are the Treatment Options for Dysphagia Lusoria?

Treatment options for dysphagia lusoria include dietary modifications, medications to manage symptoms, and in severe cases, surgical correction of the abnormal blood vessel.

Conservative Management

In mild cases, where symptoms are not severely impacting quality of life, conservative management may be recommended. This can include dietary modifications, such as eating smaller, more frequent meals and avoiding foods that are difficult to swallow.

Surgical Intervention

For patients with significant symptoms or complications, surgical intervention may be necessary. The goal of surgery is to relieve esophageal compression by repositioning or ligating the aberrant artery. Several surgical approaches exist, including:

Vascular Surgery: Re-routing the aberrant artery to alleviate compression.
Endovascular Techniques: Minimally invasive procedures to correct the vascular anomaly.
Thoracic Surgery: In cases involving Kommerell's diverticulum, surgical resection may be necessary.

Postoperative Care

Postoperative management focuses on monitoring for complications, such as infection or vascular injury, and ensuring adequate nutritional intake during the recovery period.

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What is the Recovery Process for Dysphagia Lusoria?

Recovery depends on treatment type and severity, with most patients improving after proper management.

Gradual improvement in swallowing after treatment.
Post-surgical monitoring for complications.
Diet adjustments during recovery period.
Regular follow-up to assess healing and function.
Long-term symptom management if needed.

Frequently Asked Questions

1. What are the symptoms of dysphagia lusoria?

Symptoms of dysphagia lusoria can include difficulty swallowing, pain during swallowing, and a sensation of food getting stuck, particularly when eating certain types of food.

2. What causes dysphagia lusoria?

Dysphagia lusoria is caused by an anatomical anomaly, specifically the compression of the esophagus by an aberrant right subclavian artery arising from the aortic arch, leading to swallowing difficulties.

3. How is dysphagia lusoria diagnosed?

Diagnosis typically involves imaging studies such as barium swallow or esophagram, along with clinical evaluation to assess swallowing difficulties and anatomical anomalies.