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Otolaryngology

Unusual Source of Dysphagia in a Man in His Eighth Decade of Life

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JAMA Cardiology

Published Online: June 14, 2023

Cardiovascular Images

Article Information and Disclosures

Shaina Ailawadi, MD¹;

Polsha Jules, DO²;

Damian Valencia, MD^1,2

Author Affiliations

¹Boonshoft School of Medicine, Wright State University, Dayton, Ohio
²Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio

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A man in his eighth decade of life with a medical history of transthyretin cardiac amyloidosis and severe nonrheumatic aortic stenosis (stage D1) presented with symptoms of dysphagia for 8 months and an evaluation for transcatheter aortic valve replacement. Computed tomography angiography showed an anomalous right subclavian artery and bovine carotid trunk consistent with the diagnosis of arteria lusoria, Adachi and Williams classification type H-1 (Figure). This embryologic variant of an anomalous subclavian artery arising distal to the origin of the left subclavian artery on the aortic arch has an incidence of 0.5% to 2%.¹^,2 Arteria lusoria combined with truncus bicoriticus, or common origin of the carotid arteries, is rare with a prevalence of less than 0.05%. Arteria lusoria, which courses posterior to the esophagus with symptomatic impingement, is known as dysphagia lusoria.³ Surgical intervention should be considered in symptomatic cases and with complications from aneurysmal or arterial occlusive disease.

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Article Information

Published Online: June 14, 2023. doi:10.1001/jamacardio.2023.1451

Corresponding Author: Damian Valencia, MD, Department of Cardiovascular Medicine, Kettering Health, Main Campus, 3535 Southern Blvd, Kettering, OH 45429 (damian.valencia@ketteringhealth.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Alaoui-Inboui FZ , Jouida A , Salimi S , Slaoui B . Arteria lusoria—an anatomical curiosity and a clinical entity: about 3 case reports. Arch Med Case Rep Case Study. 2022;5(5):1-5. doi:10.31579/2692-9392/126 Google Scholar Crossref

Marsafi O , Chahbi Z , Wakrim S . When Arteria lusoria meets truncus bicaroticus: one of the rarest combinations of aortic arch anomalies. Radiol Case Rep. 2021;17(2):412-415. doi:10.1016/j.radcr.2021.11.008 PubMed Google Scholar Crossref

Norris R , Wison A , Lin C . Truncus bicaroticus with arteria lusoria: a rare combination of aortic root anatomy complicating cardiac catheterization. Fed Pract. 2021;38(2):84-88. doi:10.12788/fp.0089 Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.