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Suleman M, Pyuza J, Sadiq A, Lodhia J. Aortic aneurysm: An uncommon cause of dysphagia. SAGE Open Med Case Rep 2022; 10:2050313X221135602. [PMID: 36337159 PMCID: PMC9630890 DOI: 10.1177/2050313x221135602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
Dysphagia is a serious symptom and requires urgent investigations and prompt diagnosis to initiate appropriate therapy. Dysphagia aortica is a rare entity described as difficulty in swallowing due to external compression by the aorta. The incidence of this entity is unknown. Herein we present a 90-year-old woman who presented with a progressive 3-month history of dysphagia, diagnosed with aortic aneurysm who then developed related complications and succumbed. Dysphagia aortica should be considered in the list of differential diagnoses in a patient with dysphagia although rare. Early diagnosis and management are vital to avoid poor outcomes.
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Affiliation(s)
- Mujaheed Suleman
- Department of General Surgery,
Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Jeremia Pyuza
- Department of General Surgery,
Kilimanjaro Christian Medical Center, Moshi, Tanzania,Department of Pathology, Kilimanjaro
Christian Medical Center, Moshi, Tanzania
| | - Adnan Sadiq
- Department of Radiology, Kilimanjaro
Christian Medical Center, Moshi, Tanzania,Faculty of Medicine, Kilimanjaro
Christian Medical University College, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery,
Kilimanjaro Christian Medical Center, Moshi, Tanzania,Faculty of Medicine, Kilimanjaro
Christian Medical University College, Moshi, Tanzania,Jay Lodhia, Department of General Surgery,
Kilimanjaro Christian Medical Center, PO Box 3010, Moshi, Tanzania.
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Abstract
Background Dysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica. Materials and methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades. Results A total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias. Conclusion Dysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.
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Kim JK, Son S, Suh I, Bae JS, Lim JY. Postoperative Dysphagia Aortica: Comparison with Other Dysphagia. Dysphagia 2021; 37:1112-1119. [PMID: 34546446 DOI: 10.1007/s00455-021-10370-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023]
Abstract
Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5 ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.
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Affiliation(s)
- Jong Keun Kim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Sangpil Son
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - InHyuk Suh
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jin Seok Bae
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jong Youb Lim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea.
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Meng Z, Pereira M, Sharma A. An 89-year-old man with dysphagia due to an aortic aneurysm and enlarged left atrium. CMAJ 2021; 192:E1539. [PMID: 33229350 DOI: 10.1503/cmaj.200427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ziran Meng
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man.
| | - Michael Pereira
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man
| | - Aditya Sharma
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man
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Meng Z, Pereira M, Sharma A. Dysphagie causée par un anévrisme aortique et une dilatation atriale gauche chez un homme de 89 ans. CMAJ 2021; 193:E261-E262. [PMID: 33593957 PMCID: PMC8034328 DOI: 10.1503/cmaj.200427-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ziran Meng
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man.
| | - Michael Pereira
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man
| | - Aditya Sharma
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man
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Wada T, Oyama S, Ohuchi S, Kadohama T, Takagi D, Kiryu K, Igarashi I, Yamamoto H. Calcified Aortic Wall Removal for Dysphagia Aortica Caused by Chronic Traumatic Aortic Pseudoaneurysm. Ann Vasc Surg 2021; 74:520.e23-520.e26. [PMID: 33556508 DOI: 10.1016/j.avsg.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/01/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022]
Abstract
In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.
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Affiliation(s)
- Takuya Wada
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan.
| | - Shogo Oyama
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan
| | - Shingo Ohuchi
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Itaru Igarashi
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
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White JJ, Escobedo J, Endemano J, Brodeur M, Cambron J. Young man with dysphagia. J Am Coll Emerg Physicians Open 2021; 2:e12326. [PMID: 33521778 PMCID: PMC7819262 DOI: 10.1002/emp2.12326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Joshua J. White
- Department of Emergency MedicineCHRISTUS Health‐Texas A&M College of Medicine‐Spohn Emergency Medicine ResidencyCorpus ChristiTexasUSA
| | - J.D. Escobedo
- Department of Emergency MedicineCHRISTUS Health‐Texas A&M College of Medicine‐Spohn Emergency Medicine ResidencyCorpus ChristiTexasUSA
| | - Joe Endemano
- Department of Emergency MedicineCHRISTUS Health‐Texas A&M College of Medicine‐Spohn Emergency Medicine ResidencyCorpus ChristiTexasUSA
| | - Michael Brodeur
- Department of Emergency MedicineCHRISTUS Health‐Texas A&M College of Medicine‐Spohn Emergency Medicine ResidencyCorpus ChristiTexasUSA
| | - J.D. Cambron
- Department of Emergency MedicinePella Regional Health CenterPellaIowaUSA
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Nagaya K, Naganuma M, Kudoh Y, Suzuki N, Masuda S. Compression of the Left Atrium and Left Ventricle by a Thoracoabdominal Aortic Aneurysm: A Case Report. Ann Vasc Dis 2020; 13:444-446. [PMID: 33391568 PMCID: PMC7758589 DOI: 10.3400/avd.cr.20-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a 66-year-old man with a thoracoabdominal aortic aneurysm, who presented with cardiac failure; he had complained of shortness of breath. A contrast-enhanced computed tomography scan and transthoracic echocardiography showed compression of the left atrium and ventricle by a giant thoracoabdominal aortic aneurysm. The cardiac failure resolved after early prosthetic graft replacement surgery.
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Affiliation(s)
- Koichi Nagaya
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
| | - Masaaki Naganuma
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
| | - Yasushi Kudoh
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
| | - Nobuaki Suzuki
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
| | - Shinya Masuda
- Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
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Dysphagia Aortica Caused by Congenitally Angulated Descending Aorta. Ann Vasc Surg 2020; 71:535.e7-535.e10. [PMID: 32946998 DOI: 10.1016/j.avsg.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
Dysphagia aortica is a rare pathology primarily caused by an aortic aneurysm or Kommerrell's diverticulum. Herein, we describe an extremely rare case of dysphagia aortica due to a congenitally angulated descending aorta in a 50-year-old woman successfully treated by open surgery. The woman underwent David procedure for aortic regurgitation 5 years previously, with the same anatomy of an angulated descending aorta without symptoms. She has difficulty in swallowing solid food from 1 month. Total aortic arch replacement using the elephant trunk technique and secondary descending aortic replacement released the esophageal compression by the abnormal aorta and completely improved her symptom.
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