title: Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular Ring.
abstract: A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient's symptoms.
authors.affiliation: Departments of Medicine and Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Ankur
authors.identifier: 0000-0002-6245-3115
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Departments of Medicine and Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Raheja
authors.affiliation: Departments of Medicine and Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Vinod
authors.identifier: 0000-0003-1658-0188
authors.initials: V
authors.lastname: Namana
authors.affiliation: Department of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Sunil
authors.identifier: 0000-0002-3640-9436
authors.initials: S
authors.lastname: Abrol
authors.affiliation: Divisions of Pulmonary Medicine and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kamholz
authors.affiliation: Departments of Medicine and Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Shetty