Abstract
Three patients with dysphagia caused by compression of the distal esophagus by a tortuous nonaneurysmal atherosclerotic aorta are described. All three patients were elderly women; systemic hypertension and cardiomegaly were present in two patients. Barium studies of the esophagus showed displacement and compression of the distal esophagus by the thoracic aorta. Debilitating dysphagia was treated surgically in one patient. The other two patients had milder symptoms and were managed conservatively. Esophageal manometry in these three patients showed superimposed pulsations and elevated intraluminal pressure just proximal to the lower esophageal sphincter. To evaluate the significance of these manometric findings and their correlation with clinical symptoms, we reviewed manometric tracings in 47 normal subjects. Ten of these subjects had an elevation of baseline intraluminal esophageal pressure as a result of superimposed vascular pulsations. We conclude that (1) compression of the distal esophagus by a tortuous atherosclerotic aorta in the appropriate setting can lead to clinically significant dysphagia and (2) a manometric finding of vascular compression of the esophagus does not necessarily correlate symptomatic dysphagia.
Similar content being viewed by others
References
Pape R: Uber einen abnormen verlauf (“tiefe Rechtslage”) der mesa aortitischen aorta descendens. Fortschr Roetgenstr 46:257–269, 1932
Birnholz JC, Ferrucci JT Jr, Wyman SM: Roentgen features of dysphagia aortica. Radiology 111:93–96, 1974
Sleisenger and Fordtran Gastrointestinal Disease, Pathophysiology, Diagnosis and Management, 3rd ed. Philadelphia, WB Saunders, 1983
Margulis AR, Burhenne HH: Alimentary Tract Radiology, 3rd ed. St. Louis CV Mosby, 1983, p 544
Lambert A: Surgical correction of esophageal obstruction due to tortuosity of aorta. J Thorac Cardiovascular Surg 62:973–978, 1971
Williams PL and Warwick R: Esophagus.In Gray's Anatomy, 35th ed. Philadelphia, WB Saunders, 1980, pp 1316–1317
Keates PG, Magidson O: Dysphagia associated with sclerosis of aorta. Br J Radiol 28:184–195, 1955
Mucklow EH, Smith OE: Dysphagia and unusual radiographic appearances associated with variable relationships of aorta and lower esophagus. J Fac Radiol 6:88–95, 1954
McMillan IKR, Hyde I: Compression of esophagus by aorta. Thorax 24:32–38, 1969
Berenzweig H, Baue AE, McCallum RW: Dysphagia lusoria. Report of a case and review of the diagnostic and surgical approach. Dig Dis Sci 25:630–635, 1980
Ravich WJ, Stephen RB, Donner MW, Dorst JP, Hendrix TR: Esophageal pseudospasm. The effect of extrinsic pressure on esophageal manometry. Gastroenterology 78:1241, 1980 (abstract)
Kanagasundaram N, Shumeyko M, Zweil P: Manometric characteristics of dysphagia lusoria. Gastroenterology 86:1128, 1984 (abstract)
Klinkhamer AC: Aberrant right subclavian artery clinical and roentgenologic aspects. Am J Roentgenol 97:438–446, 1966
Beachley MC, Sicoholfi EP, Madoff HR, Chaudhry RM: Dysphagia aortica. Dig Dis Sci 25:807–810, 1980
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mittal, R.K., Siskind, B.N., Hongo, M. et al. Dysphagia aortica. Digest Dis Sci 31, 379–384 (1986). https://doi.org/10.1007/BF01311673
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01311673