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A CASE WITH DYSPHAGIA DUE TO THE PRESSURE OF ABERRANT LEFT SUBCLAVIAN ARTERY
Yasin Şahin1 , Derya Aydın Şahin2 , Mehmet Kervancıoğlu2
1Çocuk Gastroenteroloji, Hepatoloji ve Beslenme Bilim Dalı, Gaziantep Üniversitesi Tıp Fakültesi, Gaziantep, Türkiye
2Çocuk Kardiyoloji Bilim Dalı, Gaziantep Üniversitesi Fakültesi, Gaziantep, Türkiye
Keywords: Aberrant left subclavian artery, gastroesophageal reflux, dysphagia

Dysphagia lusoria is used to describe the dysphagia that develops due to the pressure of vascular structures to the esophagus posteriorly. The majority of cases are associated with the aberrant right subclavian artery. A 15-year-old male was admitted to hospital with complaints of dysphagia for one year and gastroesophageal reflux (GER) was considered. Reflux scintigraphy was performed, no abnormality was detected and no treatment was given. Subsequently, the patient, who had intermittent dysphagia, was admitted to the another center. He was treated with proton pump inhibitor (PPI) for 3 months. He benefited from this treatment during the period of treatment. However, the patient, who had not used the medication for three months, developed increasing complaints especially in the consumption of solid foods. The patient then presented and was admitted to our pediatric cardiology outpatient clinic where, upon echocardiography, no abnormality except right aortic arch was detected. The vascular ring was considered as a preliminary diagnosis. Right aortic arch anomaly and an aberrant left subclavian artery were diagnosed by computed tomography (CT) and three-dimensional contrast-enhanced CT angiography, and then he was referred to the gastroenterology outpatient clinic. Upon thorough evaluation of patient’s history, it was determined that he had complains of dysphagia particularly with solid food. His physical examination was normal except epigastric tenderness. The barium esophagram demonstrated the external indentation and mild left angulation posteriorly in the middle of the esophagus secondary to the aberrant left subclavian artery at the level of aortic arch. It was thought that this image may be sufficient to explain the difficulty in swallowing. Dietary modifications and PPI medication were given. At the 3-month follow up examination, no epigastric tenderness was noted nor any other complaints were received. We present a rare case with right aortic arch anomaly and dysphagia successfully treated with dietary modifications and medication.