Recommended Citation
Stevenson JR, Scheinthal E, Kumar N, Kumar N. Dysphagia Lusoria From a Right-Sided Aortic Arch With Aberrant Left Subclavian Artery and Kommerell Diverticulum. Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P0778.
Presentation Notes
Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P0778.
Abstract
Introduction: Esophageal dysphagia is classically attributed to mechanical obstruction (solidsfirst progression) or motility disorders (mixed solid and liquid). A third, underemphasized mechanism is extrinsic vascular compression. Dysphagia lusoria results from compression by an aberrant subclavian artery, at whose origin a Kommerell diverticulum (KD) may form. The typical anatomy pairs a left aortic arch with aberrant right subclavian artery (ARSA); the rarer mirror image is a right arch with aberrant left subclavian artery (ALSA), which forms a true vascular ring with the ligamentum arteriosum. Case Description: A 56-year-old woman presented with 18 months of worsening intolerance to both solids and liquids, choking during 60% of meals with reduced oral intake. Review of systems was otherwise negative. A 2023 esophagogastroduodenoscopy (EGD) showed no mucosal lesion or extrinsic compression. Computed tomography angiography (CTA) of the chest demonstrated a right-sided aortic arch with ALSA and a 23 x 22 mm KD coursing posterior to the esophagus, stable from prior CT. Esophagram added functional information: dorsal extrinsic compression with mild ventral displacement, moderate luminal narrowing, no mucosal irregularity, and transient transverse folds (feline pattern) without visible reflux. GI judged symptoms sufficient to warrant dietary modification and repeat EGD with biopsies. Cardiothoracic surgery deferred intervention given KD size below standard thresholds, with continued surveillance. Discussion: Mixed solid-and-liquid dysphagia without mucosal disease on EGD should broaden the differential beyond motility to include extraluminal compression. Right-arch/ALSA forms a true vascular ring, predisposing to esophageal and tracheal compression. CTA defines anatomy; esophagram adds orthogonal functional information and can reveal mucosal patterns. Commonly cited surgical thresholds for KD include orifice diameter > 30 mm and apex-to-opposite-aorticwall distance > 50 mm. Discordance between objective imaging and subjective symptoms is common, favoring shared decision making and longitudinal surveillance. Feline esophagus is most often reflux-associated; without visible reflux, the differential broadens to eosinophilic esophagitis, supporting biopsies on repeat EGD. AI use disclosure: Generative AI tools assisted with literature review and language editing; no patient-identifiable information was entered, and authors verified content. Prevalence Citation: https://pubmed.ncbi.nlm.nih.gov/40860769/ Figure 1. CTA chest, axial view: right-sided aortic arch with Kommerell diverticulum (23 × 22 mm) at the origin of the aberrant left subclavian artery, coursing posterior to the esophagus (yellow circle). Figure 2. Air and barium esophagram: posterior extrinsic indentation from vascular compression with moderate luminal narrowing and mild ventral displacement of the esophagus (yellow circle).
Type
Poster
Affiliations
Aurora Health Care