Dysphagia lusoria: a rare cause of chest pain mimicking acute coronary syndrome

Introduction: Aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Hanuld first described this arterial anomaly in 1735, but its symptomatic form was first described by Bayford in 1787 as the term of „dysphagia lusoria”.
Case presentation: We report the case of a 80-year-old-man with history of aortic valve metallic prosthe-sis implantation (1998) admitted for chest pain. The results of a physical examination were unremarkable. Electrocardiogram showed sinus rhythm with major right bundle branch block with secondary repolarization disturbance. Biological markers of myocardial necrosis were normal. Echocardiography revealed segmental wall motion anomalies with a left ventricular ejection fraction of 43%. Coronary angiography via right radial artery was performed and showed epicardial coronary arteries without significant stenosis and also revealed the separate origin of the right subclavian artery from the aorta after the emergence of the left subclavian artery.
Our patient has been admitted to hospital with the working diagnosis of non-high risk non-ST elevation acute coronary syndrome. We scheduled the patient for coronarography which showed epicardial coronary arteries without significant stenosis and also revealed aberrant right subclavian artery origin from the aortic arch. The aberrant artery passes the space between es-ophagus and vertebral column or the gap between esophagus and trachea in the midline and may cause compression to the esophagus, which results in dysphagia. We reconsidered the current case and interpreted the chest pain as dysphagia lusoria.
Conclusions: Artera lusoria can be a difficult differential diagnosis for patients admitted to hospital for chest pain. The anomaly may be associated with some clini-cal manifestations such as dyspnea, stridor, dysphagia (called dysphagia lusoria), chest pain or fever, but most patients with an aberrant subclavian artery are asymp-tomatic and prone to unintentional injury during sur-gical procedures or diagnosed as an incidental surprise during coronary angiography with transradial access.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)