Aneurysm of aberrant right subclavian artery (arteria lusoria) presenting as cardiac dyspnoea.

A 75-year-old Caucasian man presented with a 3-month history of progressive dyspnoea, unrelated to position, with an exercise tolerance of 100 m. He had experienced thrombolysis following an inferior myocardial infarction 8 years previously. Initial diagnosis was cardiac dyspnoea; transthoracic echocardiogram showed moderate left ventricular dysfunction without significant progression from previous studies. Spirometry demonstrated fixed plateaued flow during forced inspiration and forced expiration. Cardiac MRI demonstrated an ejection fraction of 48% but no reversible ischaemia. Incidental note was made of an aneurysmal aberrant right subclavian artery compressing the trachea, further characterised by CT angiography (figure 1). Arteria lusoria is an anomaly occurring in 0.5e2% of individuals, but is typically asymptomatic. Aneurysmal dilatation may result in tracheal compression in the absence of dysphagia.