Arteria lusoria: a very rare cause of esophageal obstruction in a hypoxemic patient.

A male patient aged 50 years presented to the emergency department with a complaint of dysphagia after ingestion of a whole plum without chewing. His history revealed a diagnosis of schizophrenia 15 years ago. This was the patient’s second presentation to hospital with this complaint. At the first-step hospital, his relatives and the physicians did not believe the patient due to his schizophrenia after a posteroanterior X-ray examination was reported as normal. The physical examination was unremarkable, except for hypoxemia with a saturation of 75-80%. The thoracic computed tomography (CT) revealed an esophageal foreign body compatible with a silhouetted plum image at a distance of <7 cm after the epiglottis and a concomitant right subclavian artery originating as the last branch of the aortic arch (Figure 1). The CT revealed an obstruction caused by the plum, which was lodged in the esophagus just superior to where the artery followed a retroesophageal course to cross the midline (Figure 2). There was no tracheal compression or any finding that explained the hypoxemia in the CT examination. The patient underwent flexible endoscopic approach, and the foreign body (plum) was removed by breaking it into pieces and pushing it through the esophagus into the stomach. The oxygen saturation increased to within normal range, (95-97%), after endoscopic administration. The patient was discharged home after a 6-hour observation period with relief of his complaints.