title: Vascular ring presenting as dysphagia in an adult woman: a case report.
abstract: 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.
authors.affiliation: Chesterfield Royal Hospital NHS Foundation Trust , Chesterfield , UK.
authors.forename: B L
authors.initials: BL
authors.lastname: Powell
mesh_terms: D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018376:Cardiovascular Abnormalities / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D003680:Deglutition Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D054079:Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Adult; Dysphagia; Kommerell’s diverticulum; Vascular ring