An Unusual Cause of Dysphagia

Question: A 55-year-old previously healthy man presented with mild dysphagia for the past 3 months. He denied having tarry stool, weight loss, or chest pain. Physical examination was unremarkable no pallor lymphadenopathy. underwent upper endoscopy, which showed a bulging mass normal looking mucosa in esophageal region at 23 cm from incisor (Figure A). then endoscopic ultrasound dual-plane reconstruction scanning, radial B, left) and linear images right). computed tomography scan of done C). What is your diagnosis? See Gastroenterology web site (www.gastrojournal.org) more information on submitting favorite image to Clinical Challenges Images GI. The vascular structure external compression esophagus B). revealed right-sided aortic arch focal pouch (Kommerell’s diverticulum) over origin an aberrant left subclavian artery C), passes through postesophageal route compresses esophagus. 3-dimensional volume rendering reformatted D) drawing scheme E) illustrated Kommerell’s diverticulum indenting behind. Because symptoms were modest, conservative treatment chosen. Dysphagia lusoria describes as consequence esophagus.1Levitt B. Richter J.E. lusoria: comprehensive review.Dis Esophagus. 2007; 20: 455-460Crossref PubMed Scopus (87) Google Scholar Kommerell's diverticulum, described 1936, rare congenital abnormality remnant fourth dorsal arch, forming aneurysm artery.2Tanaka A. Milner R. Ota T. current era: review.Gen Thorac Cardiovasc Surg. 2015; 63: 245-259Crossref (81) can occur both right rises contralateral side. Pediatric patients often present airway symptoms, whereas discomfort are common adults. Recent studies presence cystic medial necrosis wall, could partially explain reported high risks (53%) dissection rupture, thus some authors recommended surgical aneurysms greater diameter.3Cina C.S. Althani H. Pasenau J. et al.Kommerell's arch: cohort study review literature.J Vasc 2004; 39: 131-139Abstract Full Text PDF (223) Patients moderate managed conservatively. Surgery, including open repair, hybrid endovascular total reserved those persistently severe symptoms.2Tanaka