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异物感:健康女性罕见的吞咽困难性游走食管。

Foreign body sensation: A rare case of dysphagia lusoria in a healthy female.

机构信息

Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States of America; Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States of America.

Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States of America; Northeast Ohio Medical University (NEOMED), Rootstown, OH, United States of America.

出版信息

Am J Emerg Med. 2018 Nov;36(11):2134.e1-2134.e2. doi: 10.1016/j.ajem.2018.08.029. Epub 2018 Aug 8.

Abstract

Dysphagia lusoria is a rare disease due to an aberrant right subclavian artery that passes posteriorly between the esophagus and the spine. David Bayford coined the term itself meaning "freak or jest of nature" in 1761 describing a case in which the patient had long term dysphagia that eventually led to death. Most cases of dysphagia are due to an aberrant right subclavian artery running posterior to and causing esophageal compression, but only 20-40% of aberrant arteries actually lead to trachea-esophageal symptoms, including dysphagia. The majority of patients with an aberrant right subclavian artery are asymptomatic. Treatment for dysphagia lusoria varies depending on the severity of the symptoms. Dietary modifications are recommended in patients with mild to moderate symptoms while vascular reconstruction is necessary for patients with severe symptoms. We present a 44-year-old female who was diagnosed with dysphagia lusoria due to a right-sided aortic arch and aberrant left subclavian artery (ALSA) with aneurysmal dilation. Right aortic arch with ALSA is an uncommon arch anomaly, and only occurs in about 0.05% of the population. Prior case reports of dysphagia lusoria differ in that they did not report patients with an uncommon presentation of dysphagia lusoria with aneurysmal dilatation nor was the patient diagnosed in the emergency department.

摘要

吞咽困难是一种罕见的疾病,是由于异常的右锁骨下动脉穿过食管和脊柱后面。David Bayford 在 1761 年创造了这个术语,意思是“大自然的怪胎或玩笑”,描述了一个患者长期吞咽困难最终导致死亡的病例。大多数吞咽困难是由于异常的右锁骨下动脉位于食管后面并导致食管受压引起的,但只有 20-40%的异常动脉实际上会导致气管食管症状,包括吞咽困难。大多数异常右锁骨下动脉的患者无症状。吞咽困难的治疗方法因症状的严重程度而异。对于轻度至中度症状的患者,建议进行饮食调整,对于有严重症状的患者,需要进行血管重建。我们介绍了一位 44 岁的女性,她因右位主动脉弓和左锁骨下动脉异常(ALSA)伴动脉瘤扩张而被诊断为吞咽困难。右位主动脉弓伴左锁骨下动脉异常是一种不常见的弓异常,仅发生在 0.05%的人群中。以前关于吞咽困难的病例报告有所不同,因为它们没有报告患者有不常见的吞咽困难表现伴动脉瘤扩张,也没有在急诊科诊断出患者。

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