Dysphagia due to Aortic Arch Anomaly

An unusual aortic arch anomaly produced dysphagia in a previously healthy man. Aortography performed simultaneously with a barium esophagogram disclosed a right aortic arch and right descending aorta. Esophageal compression was caused by a retroesophageal aortic diverticulum that emerged from the descending aorta and gave rise to the left subclavian artery. A left ligamentum arteriosum connected the proximal left subclavian artery and the left pulmonary artery, thus completing a vascular ring encircling the esophagus. Surgical correction was accomplished using a left thoracotomy. Division of the ligamentum as well as the junction of the aortic diverticulum and left subclavian artery freed the esophagus from its circumferential constrictions and relieved the patient's dysphagia.