Dysphagia aortica
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Dysphagia aortica Adil S. Mir 1
&
Varun Kesar 2 & Vu Q. Nguyen 2
# Indian Society of Gastroenterology 2020
A 52-year-old female with a past medical history of thoracic aortic aneurysm presented with worsening dysphagia to solids. Dysphagia had been chronically progressive with acute worsening immediately after eating dinner. She denied nausea, vomiting, or abdominal pain. Examination of this frail appearing female was otherwise grossly unremarkable. Computerized tomography (CT) scan of the chest with intravenous contrast revealed a large 8.3-cm descending thoracic aortic aneurysm causing esophageal compression (a, arrow). The patient underwent upper endoscopy, which showed esophageal luminal narrowing with impacted food due to extrinsic compression (b). The impacted food was removed with a roth net, and subsequently, a naso-duodenal feeding tube was placed using an ultra-slim gastroscope. After interdisciplinary discussion, it was decided that the risks of surgical
* Adil S. Mir [email protected] 1
Department of Internal Medicine, Carilion Clinic, Roanoke Memorial Hospital, Roanoke, VA, USA
2
Division of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
repair outweighed the benefits in our patient and conservative medical management was pursued. The patient was subsequently discharged on a dysphagia diet with pureed consistency, which she tolerated well. Although the exact incidence and prevalence remains largely unknown due to the lack of systemic data, dysphagia aortica is more prevalent among elderly females (age > 70 years), especially with a history of hypertension and kyphosis [1]. CT imaging may show aortic dilation or tortuosity. A barium swallow may reveal narrowing of the esophagus or partial esophageal obstruction [2]. Mild symptoms from dysphagia aortica may be managed conservatively with changes in dietary consistency. However, surgical repair of the aneurysm may be indicated in severely symptomatic cases or rapidly expanding aneurysms, which have an increased risk of rupture and/or dissection.
Indian J Gastroenterol
Fig. 1 (a) CT scan with intravenous contrast showing esophageal compression from the thoracic aortic aneurysm; (b) Endoscopic image showing narrowing of the esophageal lumen due to extrinsic compression
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References
Conflict of interest ASM, VK, and VQN declare that they have no conflict of interest.
1.
Chaudhry NA, Zahid K, Keihanian S, Dai Y, Zhang Q. Transmitted cardiovascular pulsations on high resolution esophageal impedance manometry, and their significance in dysphagia. World J Gastroenterol. 2017;23:7840–8. Badila E, Bartos D, Balahura C, Daraban AM. A rare cause of dysphagia - dysphagia aortica - complicated with intravascular disseminated coagulopathy. Maedica (Buchar). 2014;9:83–7.
Consent Informed consent was obtained from the patient’s husband for the publication. Unfortunately the patient has expired.
2.
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