Dysphagia Lusoria and Aberrant Right Subclavian Artery

5 44-year-old man with a history of recurrent postpranial dysphagia presented with a 2-hour history of inabilty to swallow. Esophagoduodenoscopy revealed a porion of food lodged in the proximal esophagus that was uccessfully pushed into the stomach by the endoscope. o other intrinsic esophageal abnormalities were noted, nd all laboratory values were within normal limits. An sophagogram revealed a notching of the upper esophaus from extrinsic compression (A, arrow). Chest CT ith reconstructed views revealed an aberrant origin of he right subclavian artery arising from the aorta distal to he normal left subclavian artery (B, arrow), and an exrinsic compression of the esophagus (C, thin white arow) by the aberrant right subclavian artery (C, thick hite arrow). The patient was taken to the operating oom for ligation of the aberrant vessel and reconstrucive bypass surgery. The first part of the right subclavian rtery was successfully ligated after a median sternotomy pproach and a right common carotid-subclavian artery ypass (B, thin white arrow carotid) was performed to estore blood flow to the right arm. The postoperative ourse was unremarkable and the patient was discharged ome on postoperative day 5. He remains symptom-free year after resection. Dysphagia lusoria from extrinsic esophageal compresion by an aberrant right subclavian artery was first decribed by Bayford in 1794 as lusus naturae, meaning reak or jest of nature. Aberrant right subclavian arteries ccur in about 1% of the population with the majority howing no symptoms. Abnormal involution of the