Incidental finding of an aberrant left pulmonary artery, an aberrant right subclavian artery, and a tracheal bronchus in an adult woman with a meningioma and a history of medulloblastoma

Summary: An aberrant right subclavian artery (ARSA) is a rare anatomical variation of the aortic arch. Although an incidental finding and asymptomatic in the majority of individuals, an ARSA can cause troubling symptoms during both childhood and in later life. In adulthood, the most common symptom is dysphagia, where the condition is named dysphagia lusoria. In other rare cases it can cause shortness of breath, chronic cough and hoarseness of voice amongst others. We present a case of a 65-year-old female patient who was diagnosed with dysphagia lusoria following a barium swallow examination to investigate a 10-year history of dysphagia. She was further investigated with other imaging modalities to establish her diagnosis. The dysphagia was not progressive, nor did it result in malnutrition, and hence the patient was managed conservatively. There is currently no established guideline to classify the severity of symptoms or radiological findings of this anatomical anomaly. Our case reiterates the importance of such protocols, in order to be able to avoid the risks of an unnecessary surgical procedure, whilst being sure to prevent the undertreatment of affected individuals.

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Dysphagia Lusoria Caused by Aberrant Right Subclavian Artery, Kommerell’s Diverticulum, Legamentum Ring, Right Descending Aorta, and Absent Left Pulmonary Artery: A Report of a Unique Vascular Congenital Disease Undetected until Adulthood and a Review of the Literature

Pediatric Cardiology ◽

10.1007/s00246-005-0936-1 ◽

2005 ◽

Vol 26 (6) ◽

pp. 851-855 ◽

Cited By ~ 3

Author(s):

W. Hassan ◽

A. Al Omrani ◽

M. Neimatallah ◽

F. Al Fadley ◽

Z. Al Halees

Keyword(s):

Pulmonary Artery ◽

Subclavian Artery ◽

Left Pulmonary Artery ◽

Aberrant Right Subclavian Artery ◽

Congenital Disease ◽

Review Of The Literature ◽

Descending Aorta ◽

Kommerell’S Diverticulum ◽

Absent Left Pulmonary Artery ◽

Right Descending Aorta

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Pulmonary atresia with a ventricular septal defect and left pulmonary artery discontinuity: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02750-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Hyun-Hwa Cha ◽

Hae Min Kim ◽

Won Joon Seong

Keyword(s):

Pulmonary Artery ◽

Subclavian Artery ◽

Septal Defect ◽

Left Subclavian Artery ◽

Ductus Arteriosus ◽

Main Pulmonary Artery ◽

Pulmonary Arteries ◽

Pulmonary Atresia ◽

Left Pulmonary Artery ◽

Right Pulmonary Artery

Abstract Background Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity. Case presentation A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 376/7 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation. Conclusion There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.

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Left Lung and Pulmonary Artery Hypoplasia: A Rare Case of Hemoptysis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001490 ◽

2020 ◽

Author(s):

Guiomar Pinheiro ◽

Ana Margarida Alves ◽

Isabel Neves ◽

Teresa Sequeira

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Hypoplasia ◽

Left Lung ◽

Left Pulmonary Artery ◽

Pulmonary Infections ◽

Rare Congenital Disorder ◽

History Of ◽

Pulmonary Artery Hypoplasia

Pulmonary hypoplasia or agenesis is a rare congenital disorder that results in lung underdevelopment. This disease is usually found in children but rarely encountered in adults. We describe the case of an 84-year-old woman diagnosed with a unilateral pulmonary hypoplasia presenting simultaneously with left pulmonary artery hypoplasia. Due to this condition, the patient had a lifelong history of pulmonary infections that resulted in several bronchiectases in the affected lung. Moreover, the pulmonary artery hypoplasia led to the development of pulmonary hypertension and collateral circulation causing hemoptysis, giving rise to the patient attending the emergency department. Although we were able to medically manage the hemoptysis, it can be fatal and require surgical intervention. Hence, an early diagnosis is essential so that appropriate follow-up and prompt prevention and treatment of complications, such as pulmonary infections, hemoptysis and pulmonary hypertension, are achieved.

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Repair of a type B aortic dissection with a re-vascularization of the aberrant right subclavian artery in an adult patient

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1031-7 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Mahmoud Yousef Ibrahim Abuharb ◽

Bian Xiao Ming ◽

He Jian

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Incidental Finding ◽

Aberrant Right Subclavian Artery ◽

Uneventful Recovery ◽

Type B ◽

Type B Aortic Dissection ◽

Case Presentation ◽

Therapeutic Implications ◽

Aortic Branch

Abstract Background An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. Case presentation We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. Conclusion Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.

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Prenatal Echocardiographic Diagnosis of a Right Aortic Arch and Bilateral Arterial Duct With Isolation of the Left Subclavian Artery From the Left Pulmonary Artery

Journal of Ultrasound in Medicine ◽

10.7863/jum.2007.26.8.1107 ◽

2007 ◽

Vol 26 (8) ◽

pp. 1107-1110 ◽

Cited By ~ 3

Author(s):

Chandrakant R. Patel ◽

Grace L. Smith ◽

John R. Lane ◽

Haynes B. Robinson

Keyword(s):

Pulmonary Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Left Pulmonary Artery ◽

Right Aortic Arch ◽

Arterial Duct

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Co-Occurrence of Rarest Type of Dysphagia Lusoria (Type N-1) and Eosinophilic Esophagitis in a Cognitively Disabled Individual

Case Reports in Medicine ◽

10.1155/2019/2890635 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kishore Kumar ◽

Jasbir Makker ◽

Hassan Tariq ◽

Ariyo Ihimoyan ◽

Chime Chukwunonso ◽

...

Keyword(s):

Subclavian Artery ◽

Eosinophilic Esophagitis ◽

Previous History ◽

Food Allergies ◽

Aberrant Right Subclavian Artery ◽

Food Impaction ◽

Diagnostic Challenge ◽

Dysphagia Lusoria ◽

Extrinsic Compression ◽

History Of

Dysphagia is an expressive symptom, described by an individual as “difficulty in swallowing.” Dysphagia due to esophageal compression from an aberrant right subclavian artery is rare, and it is termed as “dysphagia lusoria.” We present a rare case of co-occurrence of dysphagia lusoria with esophageal eosinophilia in a patient with cognitive disability which portends a case with diagnostic challenge and treatment dilemma. A 31-year-old man with intellectual disability, cerebral palsy, previous history of feeding difficulty, and esophageal food impaction presented with esophageal foreign body impaction. He has no known history of atopy and food allergies. There was no laboratory evidence of peripheral eosinophilia. The IgE-mediated allergic test was unremarkable. His prior presentation revealed a diagnosis of eosinophilic esophagitis. The imaging studies showed proximal esophageal dilatation with extrinsic compression at the level of the upper esophagus. The foreign bodies were removed successfully through the help of upper endoscopy. Subsequent evaluation revealed a rare type of dysphagia lusoria (type N-1) due to an aberrant left subclavian artery arising from the right-sided aortic arch. The patient’s family refused further management of artery lusoria. Prolonged stasis of secretions and food in the esophagus can also lead to increased esophageal eosinophils. In our case, it remains undetermined whether increased number of esophageal eosinophils resulted from primary eosinophilic esophagitis or due to prolonged food stasis from esophageal compression caused by an aberrant subclavian artery. However, food impaction right above the compression site makes dysphagia lusoria the likely etiology.

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Incidental finding of aberrant subclavian artery during computed tomography scan

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v3i4.13376 ◽

2015 ◽

Vol 3 (4) ◽

pp. 162-164

Author(s):

Mubarak Mohd Yusof ◽

Sharini Shamsudin

Keyword(s):

Computed Tomography ◽

Weight Loss ◽

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Incidental Finding ◽

Right Aortic Arch ◽

Aberrant Right Subclavian Artery ◽

Computed Tomography Scan ◽

Tomography Scan

Two cases of aberrant subclavian arteries were detected incidentally during computed tomography scan of the thorax for other medical conditions. The patients did not have weight loss or dysphagia lusoria. The origin and course of theaberrant subclavian arteries are related to the anomaly of the aortic arch. The variations of aberrant right subclavian artery with left aortic arch and aberrant left subclavian artery with right aortic arch on computed tomography are discussed.Journal of Kathmandu Medical CollegeVol. 3, No. 4, Oct.-Dec., 2014Page: 162-164

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