A Rare Case of Adult Dysphagia: Dysphagia Lusoria

Navigating the Unexpected: Dysphagia Lusoria Complicates Severe Pneumonia With Parapneumonic Effusion

Managing pneumonia, especially when complicated by underlying anatomical anomalies, presents unique challenges that require a nuanced and multidisciplinary approach. Dysphagia lusoria, a rare vascular anomaly where the right subclavian artery originates aberrantly, can coexist with other thoracic conditions, complicating both diagnosis and treatment. Understanding the interplay between such anomalies and common infections like pneumonia is crucial for optimal patient outcomes. This case report describes a 33-year-old male with a history of recurrent pneumonia in the past who presented to the emergency department (ED) with right flank pain and dyspnea persisting for one week. Initial investigations revealed moderate parapneumonic pleural effusion and right lower lobe pneumonia. At the time, an aberrant origin of the right subclavian artery (ARSA) (dysphagia lusoria) was incidentally detected on imaging. The patient's management included antibiotic therapy tailored for pneumonia and the placement of a chest tube for pleural effusion drainage. Despite intermittent dysphagia, surgical intervention for dysphagia lusoria was deferred due to its minimal impact on daily functioning. The patient improved significantly with supportive care and antibiotics, highlighting the complexity of managing pneumonia complicated by anatomical anomalies. This case underscores the importance of multidisciplinary management and tailored treatment strategies in addressing intricate clinical scenarios.

Dysphagia With Unusual Etiology: A Case Report

Here, we present a case of dysphagia with a very unusual etiology. Dysphagia is a symptom of concern and can occur secondary to multiple etiologies. Therefore, prompt and appropriate evaluation is necessary, as treatment varies depending on the underlying cause. Our patient was a 73-year-old female admitted for dysphagia associated with recent significant weight loss and a history of long-term smoking. A CT scan of her neck revealed a mass that was compressing the esophagus, but the etiology of the mass was unexpected. This case highlights the importance of considering rare causes of dysphagia and underscores the need for physicians to be aware of them.

Ortner syndrome caused by aberrant right subclavian artery: A case report

INTRODUCTION

Ortner syndrome (cardiovocal hoarseness) is characterized by recurrent laryngeal nerve paralysis secondary to a cardiovascular abnormality. Ortner syndrome caused by an aberrant right subclavian artery following a retroesophageal course without aneurysm formation is rare, with only 1 case reported in the literature. Cardiovascular abnormalities could be life-threatening and require early diagnosis and treatment. However, such abnormalities are not often considered by clinical practitioners when patients initially present with hoarseness.

PATIENT CONCERNS

A 34-year-old woman without any medical history presented to our outpatient department with hoarseness and mild dysphagia for 1 month.

DIAGNOSIS

Upon stroboscopic examination, left vocal cord incomplete paralysis was noted. Contrast-enhanced computed tomography revealed an aberrant right subclavian artery arising from the left aortic arch, causing focal compression of the esophagus and, potentially, compression of the left recurrent laryngeal nerve compression. The patient was diagnosed as left recurrent laryngeal nerve paralysis caused by an aberrant right subclavian artery following a retroesophageal course without aneurysm formation.

INTERVENTIONS

The patient was referred to a cardiovascular surgeon for resection and bypass surgery. Both the dysphagia and the hoarseness improved after the surgery.

OUTCOMES

Significant improvement of the left vocal cord paralysis and no vocal cord adduction were seen upon stroboscopic examination after 3 months. During the 5-year follow-up period, the patient remained well, and no signs of recurrence were noted.

CONCLUSION

This case can increase otolaryngologists' awareness of this etiology of hoarseness and consider it in their differential diagnosis.