scholarly journals Vascular ring presenting as dysphagia in an adult woman: a case report

2017 ◽  
Vol 99 (1) ◽  
pp. e3-e5 ◽  
Author(s):  
BL Powell
Keyword(s):  
Aortic Arch ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Barium Swallow ◽  
Common Symptom ◽  
Kommerell’S Diverticulum ◽  
History Of ◽  
Swallow Study ◽  
Computed Tomography Angiogram

A 48-year-old woman was seen in a surgical outpatient clinic with a 2 year history of progressive dysphagia with occasional regurgitation, partially controlled with a proton pump inhibitor. Primary investigations of pH testing and gastroscopy were normal, although a barium swallow study revealed significant hold-up at the aortic arch impression and a posterior right-sided oesophageal impression suggestive of a right-sided aortic arch. A follow-up computed tomography angiogram discovered a vascular ring encircling the trachea and oesophagus, formed by a right-sided aortic arch with aberrant aortic branches, and a Kommerell’s diverticulum. It was deemed that the patient’s symptoms were related to this vascular ring. The patient underwent stage-one surgery – an extra-anatomic bypass of the double aortic arch and right subclavian artery – and 4 months later a stent graft insertion over the origin of the diverticulum with the aim of complete symptomatic relief. This case presents a common symptom familiar to any clinician (dysphagia), which has been caused by a rare pathology. It is even more unusual that this should present itself in adulthood.

Vascular ring surgery – can we do better?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Amir ◽  
N Soffair ◽  
G Frenkel ◽  
E Bruckheimer ◽  
E Nachum ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Respiratory Symptoms ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Mirror Image ◽  
Vascular Rings ◽  
Number Of Patients ◽  
Age At Surgery

Abstract Background Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. Methods Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery. Results In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up Conclusions Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms. Funding Acknowledgement Type of funding source: None

74 LAPAROSCOPIC MANAGEMENT OF A PULSION EPIPHRENIC OESOPHAGEAL DIVERTICULUM SECONDARY TO ACHALASIA.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jeremy Tan ◽  
Baldwin Yeung ◽  
Lester Ong ◽  
Bin Chet Toh ◽  
Wai Keong Wong ◽  
...  
Keyword(s):  
Laparoscopic Resection ◽  
Barium Swallow ◽  
Toupet Fundoplication ◽  
Rare Entity ◽  
Upper Gi ◽  
Operative Complications ◽  
History Of ◽  
Upper Gi Endoscopy

Abstract   This is a video submission of a laparoscopic resection of an epiphrenic oesophageal pulsion diverticulum secondary to achalasia. A Heller’s cardiomyotomy is also performed together with a Toupet fundoplication. Methods The patient is a 40 year old woman with a 12 month history of worsening dysphagia, reflux symptoms, as well as occasional regurgitation of food, worse at night. Barium swallow showed a distal oesophageal diverticulum and oesophageal manometry confirmed type 1 achalasia. Upper GI endoscopy showed no other intra-luminal findings. Results The patient underwent a laparoscopic resection of the diverticulum, together with a Heller’s cardiomyotomy and Toupet fundoplication. There were no post-operative complications. She remains well and asymptomatic at 9 month follow-up. Conclusion Pulsion diverticula secondary to achalasia are a known but rare entity. A few variations exist on how to manage this condition surgically, especially with respect to the type of fundoplication. We present our preferred technique for dealing with this condition. Video https://www.dropbox.com/s/dg4edkamykugupn/Oesophagealdivert.mp4?dl=0

Double aortic arch: an elusive diagnosis in a child with CHD

2021 ◽  
pp. 1-3
Author(s):  
Mariana Lemos ◽  
Miguel Fogaça da Mata ◽  
Ana Coutinho Santos
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Ct Angiography ◽  
Septal Defect ◽  
Vascular Ring ◽  
Pulmonary Atresia ◽  
Double Aortic Arch ◽  
Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

scholarly journals Kommerell’s Diverticulum With a Twist: A Case of Recurrent Wheeze in an 8-Year-Old Boy

2019 ◽  
Vol 6 ◽  
pp. 2333794X1989750
Author(s):  
Tiffany Amber Robles ◽  
Aditya Srinivasan ◽  
Lynnette Mazur ◽  
Anand Gourishankar
Keyword(s):  
Aortic Arch ◽  
Pediatric Patient ◽  
Respiratory Symptoms ◽  
Vascular Ring ◽  
Anatomical Variant ◽  
Vascular Abnormalities ◽  
Aortic Arch Anomaly ◽  
Asthma Exacerbations ◽  
Kommerell’S Diverticulum ◽  
Recurrent Wheeze

Kommerell’s diverticulum is a rare, congenital aortic arch anomaly, usually associated with other vascular abnormalities. When present with a concurrent right-sided aortic arch and an aberrant subclavian artery, this triad can form a vascular ring that encompasses the trachea and esophagus. This anatomical variant is usually asymptomatic but can present with respiratory symptoms due to compression of the trachea. In this report, we discuss a case of a Kommerell’s diverticulum, which presented as frequent and recurring asthma exacerbations in a pediatric patient.

Surgical Management of Right Aortic Arch Obstruction Associated With Rare Form of Vascular Ring

2020 ◽  
Vol 11 (2) ◽  
pp. 222-225
Author(s):  
Evgeny V. Krivoshchekov ◽  
Frank Cetta ◽  
Oleg A. Egunov ◽  
Evgenii A. Sviazov ◽  
Valeriy O. Kiselev ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Surgical Management ◽  
Rare Case ◽  
Vascular Ring ◽  
Right Aortic Arch ◽  
Rare Form ◽  
Descending Aorta ◽  
Arch Obstruction ◽  
Right Descending Aorta

This clinical case demonstrated surgical management for a rare case of vascular ring associated with an elongated and kinked aortic arch and a right descending aorta in a ten-year-old male using an extra-anatomic bypass grafting method and dividing the vascular ring. Computer tomography performed at six-month follow-up showed a favorable surgical outcome.

scholarly journals P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E A Khalifa ◽  
S Helmy ◽  
S F Mohamed ◽  
M Alkuwari
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Coarctation Repair ◽  
History Of ◽  
Dacron Patch

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

scholarly journals Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Salvatore Maria Antonio Campo ◽  
Roberto Lorenzetti ◽  
Marina de Matthaeis ◽  
Cesare Hassan ◽  
Angelo Zullo ◽  
...  
Keyword(s):  
Old Age ◽  
Iron Deficiency Anaemia ◽  
Gastrointestinal Endoscopy ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Metal Stent ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

scholarly journals Retropharyngeal space lipoma: an unusual cause of dysphagia

2021 ◽  
Vol 7 (2) ◽  
pp. 379
Author(s):  
Chinyere N. Asoegwu ◽  
Nkiruka A. Wakwe ◽  
Clement C. Nwawolo
Keyword(s):  
Neck Region ◽  
Positive Sign ◽  
Barium Swallow ◽  
Retropharyngeal Space ◽  
Head And Neck Region ◽  
Solid Foods ◽  
Presenting Symptoms ◽  
History Of ◽  
Progressive Dysphagia

<p class="abstract">Lipomas are uncommon in the head and neck region and rare in the retropharyngeal space. Lipoma of the retropharyngeal space may cause aerodigestive tract obstruction presenting as dyspnea and or dysphagia. The presenting symptoms will depend on the size and site of the lipoma in the retropharyngeal space. We present the case of a 57 years old male with 6 months’ history of progressive dysphagia to solid foods only and no positive sign on clinical examination. The barium swallow was normal. The computed tomography (CT) scan showed a moderate-sized homogenous mass of fat density in the hypopharyngeal section of the retropharyngeal space. Diagnosis of dysphagia caused by retropharyngeal lipoma was made. This was surgically excised via the trans-cervical route with no complications, complete resolution of symptoms, and no recurrence 2 years after on follow-up. In the dysphagia of unknown cause, retropharyngeal space lipoma should be considered.</p>

scholarly journals Laryngomalacia and Swallow Dysfunction

2019 ◽  
Vol 98 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Brian L. Scott ◽  
Derek Lam ◽  
Carol MacArthur
Keyword(s):  
Medical Center ◽  
Patient Characteristics ◽  
Barium Swallow ◽  
Male Predominance ◽  
Surgical History ◽  
Swallow Study ◽  
Modified Barium Swallow Study ◽  
The Relationship ◽  
Poor Weight Gain

Objectives: Laryngomalacia is an established cause of stridor and sleep-disordered breathing in children. However, the relationship between laryngomalacia and dysphagia has not been well characterized. The objectives of this study were to (1) describe the patient characteristics, symptoms, and prevalence of dysphagia in children with laryngomalacia and (2) examine the effectiveness of supraglottoplasty in improving feeding. Methods: This was a retrospective study of patients with laryngomalacia who underwent a modified barium swallow study (MBSS) at a tertiary academic pediatric medical center between March 1, 2014, and March 1, 2018. Patients were excluded if they did not undergo a MBSS. Comorbidities, airway and feedings symptoms, MBSS results, and surgical history were recorded from each patient’s electronic medical record. Results: Forty-four children met inclusion/exclusion criteria. The median age at presentation was 96 days. There was a male predominance (66%). About one-third had a genetic or neuromuscular comorbidity. Most children had stridor (93%) and feeding difficulty (86%), while 50% had parent-reported poor weight gain. Fifty-seven percent of patients had evidence of penetration or aspiration on MBSS. All patients with a positive MBSS had dysphagia symptoms. Fifty-seven percent of patients underwent supraglottoplasty. Postoperatively, 92% reported improvement in dysphagia symptoms. Conclusion: Dysphagia is prevalent among a subset of children with laryngomalacia. Symptomatic children may benefit from a swallow evaluation to help determine the need for further intervention. Children who undergo supraglottoplasty for laryngomalacia have improved dysphagia at follow-up, though the amount of improvement directly attributable to surgery is unclear and warrants further investigation.

Adult Aortotracheal Fistula as Sequela of Double Aortic Arch Repair in Infancy: A Case Report

2020 ◽  
Vol 129 (7) ◽  
pp. 649-652
Author(s):  
Andrew B. Rees ◽  
Jennifer P. Rodney ◽  
Mark R. Gilbert ◽  
Clayton A. Kaiser ◽  
Alexander H. Gelbard
Keyword(s):  
Aortic Arch ◽  
Digeorge Syndrome ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Vascular Ring ◽  
Clinical History ◽  
Double Aortic Arch ◽  
Aortic Arch Repair ◽  
Early Surgical Intervention

Introduction: Double aortic arch is a rare congenital malformation of the aortic arch that most frequently presents in childhood. Early surgical intervention typically yields excellent outcomes. Objectives: To describe aortotracheal fistula as a rare, yet serious complication of vascular ring and subsequent aortic aneurysm in an adult patient. Methods: Clinical history, as well as radiographic and endoscopic imaging were obtained to describe the development, diagnosis, and clinical course of this patient’s aortotracheal fistula. Additionally, follow up data was obtained to document the healing of this fistula after surgical repair. Results: We describe a case of a 46-year-old male with DiGeorge Syndrome and a double aortic arch, repaired in childhood, which developed into an aortotracheal fistula after tracheostomy placement as an adult. Conclusions: This case demonstrates that dangerous complications of a double aortic arch can persist into adulthood, even after surgical repair in infancy. Each patient’s unique anatomy must be considered when thinking about airway management and prevention of complications of this rare congenital anomaly.

Sign in / Sign up

Export Citation Format

Share Document