Dysphagia due to an aberrant left subclavian artery in a right-sided aortic arch.

In 1794, Bayford described the post-mortem findings of a woman with lifelong dysphagia who eventually died of starvation, caused by oesophageal obstruction.' At post-mortem a right subclavian artery was identified passing aberrantly from a left-sided aortic arch behind the oesophagus, causing the woman's dysphagia. Dr Bayford referred to this extraordinary disposition ofthe right subclavian artery as, lusus nature or sport of nature. Since then the term 'dysphagia lusoria' has been used to refer to all aortic root anomalies causing oesophageal dysphagia.2 We report a case ofdysphagia lusoria caused by a right aortic arch with a large diverticulum (diverticulum of Kommerell3) at the origin of an aberrant left subclavian artery. CASE REPORT A 45 year old lady presented with a 2 month history of fatigue, shortness of breath, and a feeling of tightness at the lower end Fig 1 Barium meal image showing compression of the oesophagus by an aberrant vessel. ofher sternum associated with occasional episodes of dysphagia. Physical examination was unremarkable. Her ECG was normal. A chest radiograph demonstrated a right sided aortic arch. A subsequent barium meal demonstrated an area of constriction in the upper third of the thoracic oesophagus with an indentation arising posteriorly causing compression and contrast hold up. (Fig 1). The indentation corresponded to the level of the aortic arch and the radiological appearances suggested this was due to an aberrant vessel. Fig 2. Axial Ti1-Weighted MR image through the thorax shows the right-sided aortic arch (open arrow) and the aberrant left subclavian artery with the wide mouthed diverticulum of Kommerell at its origin (closed arrow).