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J Korean Dysphagia Soc 2022; 12(2): 143-147

Published online July 30, 2022 https://doi.org/10.34160/jkds.2022.12.2.009

© The Korean Dysphagia Society.

Dysphagia Aortica Initially Misdiagnosed as Poststroke Dysphagia: A Case Report

InHyuk Suh, M.D., Sangpil Son, M.D., Jong Keun Kim, M.D., Jong Youb Lim, M.D., Ph.D.

Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea

Correspondence to:Jong Youb Lim, Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea
Tel: +82-42-611-3631, Fax: +82-42-611-3633, E-mail: jylimmd@eulji.ac.kr

Received: December 10, 2021; Revised: December 13, 2021; Accepted: March 24, 2022

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dysphagia aortica is a rare form of mechanical dysphagia characterized by extrinsic compression of the esophagus by the aorta. A 69-year-old male reported experiencing swallowing difficulties for five months, along with nausea, abdominal discomfort, weight loss, and severe reflux. Considering his age and a medical history of hypertension and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. However, brain magnetic resonance imaging revealed no evidence of acute or subacute stroke. Further evaluation was achieved via enhanced chest computed tomography to locate the focus of the systemic inflammation. A thoracic aortic aneurysm about 8.7×5.0 cm in size, with signs of impending rupture, was observed. This case reinforces that a high possibility for dysphagia aortica should be considered under conditions of unclear etiology of dysphagia but the presence of associated symptoms, such as progressive intolerance to solids and ultimately to liquids, weight loss, and nausea.

Keywords: Deglutition disorders, Dysphagia aortica, Esophageal dysphagia, Aortic aneurysm

Dysphagia, which is classified as oropharyngeal or esophageal dysphagia according to the involved phase of swallowing, can result from a wide variety of possible causes, including neuromuscular, mechanical, and functional conditions1. The most common cause of neuromuscular dysphagia is stroke, which is the leading cause of oropharyngeal dysphagia. Dysphagia aortica, which is caused by extrinsic compression of the esophagus by the aorta, is a rare form of me-chanical dysphagia2. As dysphagia can lead to crucial complications, such as malnutrition, pneumonia, or airway obstruction, its cause should be diagnosed correctly3. This report presents a case of dysphagia aortica that was initially suspected as poststroke dysphagia.

A 69-year-old male with hypertension and diabetes mellitus visited the outpatient department of rehabilitation medicine because of swallowing difficulty. The symptom started five months ago, along with nausea and abdominal discomfort. He first visited the gastroenterology department, but there were no abnormal findings in both endoscopy and abdominal computed tomography. The symptom worsened, with significant malnutrition and weight loss of more than 10 kg in those five months. Further evaluation, such as thyroid ultrasonography and fine-needle aspiration biopsy, was conducted in the endocrinology department to distinguish other potential causes of weight loss, but there were no definite abnormal findings. He also visited the psychiatry department to evaluate possible psychiatric causes. Antidepressants were prescribed for a diagnosis of major depressive disorder. However, the symptom was still aggravated, even after the patient took antidepressants for more than one month. Lastly, he visited the outpatient department of rehabilitation medicine and the neurology department. He had been taking aspirin and clopidogrel from the neurology outpatient department since he had vertigo and was diagnosed with intracranial vertebral artery stenosis by brain magnetic resonance angiography (MRA) four years ago. At this moment, he could hardly swallow anything, including thin and thick liquids. Whenever he succeeded in swallowing, vomiting would follow. He described the feeling of having food stuck in the suprasternal notch and severe reflux after swallowing. Regarding his age and medical history of hypertension, diabetes mellitus, and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. He was admitted to the neurology department for evaluation of stroke.

Videofluoroscopic swallowing study (VFSS) was performed upon admission. The results were as follows: supraglottic penetration during liquid drinking with a cup or straw, oral transit time of 1.24 s, delayed pharyngeal transit time of 1.02 s, increased vallecular and pyriform residue, and decreased laryngeal elevation of 1.1 cm. Additionally, in the esophageal phase, delayed emptying of the esophagus, food reflux, and esophageal dilatation were observed.(Fig. 1) Oropharyngeal dysphagia combined with esophageal dysphagia was therefore suggested. For evaluation of stroke, brain magnetic resonance imaging including diffusion-weighted imaging and angiography was done; however, there was no evidence of acute or subacute stroke and no definite change of intracranial vertebral artery stenosis compared to the previously taken brain MRA. Laryngoscopy was performed to evaluate the anatomical structure and there were no abnormal findings.

Figure 1. Videofluoroscopic swallowing study findings. The arrow shows extrinsic compression of the esophagus by the thoracic aortic aneurysm.

At the time of admission, laboratory examination showed a white blood cell count of 6,230/mm3 (normal range: 3,800–10,500/mm3) and a C-reactive protein (CRP) level of 20.78 mg/dL (normal range: 0–0.5 mg/dL). A simple chest radiograph showed no definite evidence of active consolidation in both lung fields, and urine analysis was clear. He had no symptoms other than swallowing difficulty that implied any cause of systemic inflammation. Two days after performing VFSS, further radiologic evaluation was conducted with enhanced chest computed tomography to identify the focus of the systemic inflammation. A thoracic aortic aneurysm sized about 8.7×5.0 cm with the progression of deep ulcerating atheroma suggesting impending rupture was seen. On the axial view, the enhanced upper esophagus with residual barium implied near complete obstruction,(Fig. 2A) and a thoracic aortic aneurysm was compressing the thoracic part of the esophagus and was making it hardly visible below the upper esophagus.(Fig. 2B, C) The patient was transferred to the chest surgery department, and thoracic endovascular aortic repair (TEVAR) was done urgently.

Figure 2. Enhanced chest computed tomography findings. (A) The arrow shows the enhanced upper esophagus with residual barium which implies near complete obstruction by the thoracic aortic aneurysm. (B) The black arrow shows the hardly visible thoracic part of the esophagus compressed by the thoracic aortic aneurysm (white arrow). (C) The coronal view shows the dilated upper esophagus (white short arrow) and thoracic aortic aneurysm (white arrow) compressing the thoracic part of the esophagus.

Three weeks after the operation the patient was transferred to the general ward, and esophagography was performed.(Fig. 3) There was no definite evidence of contrast leakage and oral feeding was initiated with a small amount of puree diet. Gradually, the patient’s diet was altered to a regular diet.

Figure 3. Esophagography findings. No definite evidence of contrast leakage is identified.

Causes of dysphagia vary across the world, and various diagnostic methods have been established, such as VFSS, fiberoptic endoscopic evaluation of swallowing, esophagogastroduodenoscopy, esophageal manometry, and chest computed tomography4. Selection of proper diagnostic methods is needed for efficacy. In rehabilitation medicine, VFSS is used as an initial evaluation tool of dysphagia. Poststroke dysphagia is the leading cause of oropharyngeal dysphagia, especially in patients with risk factors, such as old age, hypertension, diabetes mellitus, and arrhythmia. Early diagnosis of stroke is important for acute management. However, in this case, during evaluation to find the presence of newly developed stroke, dysphagia aortica was initially suspected as poststroke dysphagia. Diagnosis of impending aortic rupture was done after initial evaluation.

There is no gold standard diagnostic method for dysphagia aortica5. If there are associated symptoms, such as progressive intolerance to solids and ultimately liquids, weight loss, nausea, and vomiting, dysphagia aortica should be considered2,6. In this case, the patient had these symptoms in addition to esophageal phase abnormalities found by VFSS, such as delayed emptying of the esophagus, food reflux, and esophageal dilatation. Along with esophageal phase abnormalities, dysphagia aortica has an oropharyngeal component. Unilateral vocal cord palsy occurs if the left recurrent laryngeal nerve is compromised at the aortic arch and it increases the risk of aspiration by impairing epiglottic tilting, closure of the vocal folds, and laryngeal elevation7. The association of suggestive symptoms, along with the results of VFSS, led to a high index of suspicion. Further diagnostic methods, such as chest computed tomography, esophagogastroduodenoscopy, and esophageal manometry, might be considered for evaluation of non-neurogenic dysphagia.

Chest computed tomography can show the enlargement of the aortic arch, tortuous dilation of the aorta, or direct compression of the esophagus by an aortic aneurysm5. Esophagogastroduodenoscopy may reveal external compression of the esophagus and stenosis of the lower esophagus with proximal dilatation by a tortuous aorta, and this can be replaced with a barium swallow where esophageal wall indentation and partial esophageal obstruction by a pulsatile mass are present8,9. Esophageal manometry may find a focal high-pressure band with superimposed pulsations10. CRP can be elevated in patients with dysphagia aortica indicating vessel wall inflammation. There is a systematic review that elevated CRP levels indicate increased mortality in aortic dissection due to the inflammatory process within the wall making the damaged aorta more prone to redissection and rupture11.

Upon diagnosis with dysphagia aortica, a treatment plan is established in accordance with the severity of symptoms. Mild cases can be treated conservatively using diet modification and management of underlying diseases12. In severe cases, surgery should be considered, such as transposition of the distal esophagus, separation of the esophagus from the aorta, esophagomyotomy, esophageal stenting, and aortic aneurysm repair5. Patients with severe symptoms who cannot undergo surgical intervention can be symptomatically managed with insertion of a percutaneous endoscopic gastrostomy tube13.

Dysphagia aortica is a rare form of dysphagia, but misdiagnosis can lead to devastating results14. We report one of the few cases of dysphagia aortica successfully treated with TEVAR. However, even in this case, earlier diagnosis could have led to earlier surgical intervention for the aortic aneurysm, and a better prognosis could have been made. Our case reinforces that a high index of suspicion for dysphagia aortica should be maintained when the etiology of dysphagia is unclear and associated symptoms are present, such as progressive intolerance to solids and ultimately liquids, weight loss, and nausea.

The authors declare that they have no conflict of interest.

IS was a major contributor in writing the manuscript. JYL was involved in drafting the manuscript and revising it for intellectual content. SS and JKK analyzed and interpreted the patient data regarding dysphagia. All authors read and approved the final manuscript.

  1. Choi SHJ, Yang GK, Gagnon J. Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement. J Vasc Surg Cases Innov Tech 2019;5:501-5. https://doi.org/10.1016/j.jvscit.2019.08.008.
    Pubmed KoreaMed CrossRef
  2. Kim JH, Jang SW, Kim DB, Lee HJ, Kim JG, Kwon BJ, et al. A patient with dysphagia due to an aortic aneurysm. Korean Circ J 2009;39:258-60. https://doi.org/10.4070/kcj.2009.39.6.258.
    Pubmed KoreaMed CrossRef
  3. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Rep 2013;1:187-96. https://doi.org/10.1007/s40141-013-0017-y.
    Pubmed KoreaMed CrossRef
  4. Abdel Jalil AA, Katzka DA, Castell DO. Approach to the patient with dysphagia. Am J Med 2015;128:1138.e17-23. https://doi.org/10.1016/j.amjmed.2015.04.026.
    Pubmed CrossRef
  5. Chan YH, Hung CY, Shieh TY, Wang HY, Chang CW, Shih SC, et al. Nonaneurysmatic dysphagia aortica in the elderly: three case reports and literature review. Int J Gerontol 2016;10:52-5. https://doi.org/10.1016/j.ijge.2014.12.003.
    CrossRef
  6. Hilliard AA, Murali NS, Keller AS. Dysphagia aortica. Ann Intern Med 2005;142:230-1. https://doi.org/10.7326/0003-4819-142-3-200502010-00031.
    Pubmed CrossRef
  7. Lee SI, Pyun SB, Jang DH. Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome. Dysphagia 2006;21:129-32. https://doi.org/10.1007/s00455-006-9015-x.
    Pubmed CrossRef
  8. Coelho-Prabhu N, Baron TH. Dysphagia and weight loss in an elderly person. Dysphagia aortica. Gastroenterology 2009;137:e1-2. https://doi.org/10.1053/j.gastro.2009.02.011.
    Pubmed CrossRef
  9. Mouawad NJ, Ahluwalia GS. Dysphagia in the aging cardiovascular patient. J Thorac Dis 2017;9:E1005-8. https://doi.org/10.21037/jtd.2017.10.59.
    Pubmed KoreaMed CrossRef
  10. Park SY, Lee JH, Cho SB, Lee WS, Park CH, Kim HS, et al. Aggravation of dysphagia aortica after wearing the abdominal binder. J Neurogastroenterol Motil 2010;16:323-6. https://doi.org/10.5056/jnm.2010.16.3.323.
    Pubmed KoreaMed CrossRef
  11. Vrsalović M, Vrsalović Presečki A. Admission C-reactive protein and outcomes in acute aortic dissection: a systematic review. Croat Med J 2019;60:309-15. https://doi.org/10.3325/cmj.2019.60.309.
    Pubmed KoreaMed CrossRef
  12. Karavelioğlu Y, Kalçik M, Yetim M, Sarak T, Bekar L, Doğan T. A rare cause of dysphagia and weight loss in a Nonagenarian with hypertension: dysphagia aortica. J Am Geriatr Soc 2015;63:1488-9. https://doi.org/10.1111/jgs.13544.
    Pubmed CrossRef
  13. Badila E, Bartos D, Balahura C, Daraban AM. A rare cause of dysphagia - dysphagia aortica - complicated with intravascular disseminated coagulopathy. Maedica (Bucur) 2014;9:83-7.
    Pubmed KoreaMed
  14. Liao CY, Huang SC, Wang YC, Chin HK, Tsai CC, Ben RJ, et al. Dysphagia aortica: a fatal delay in diagnosis. Am J Emerg Med 2015;33:1117.e3-5. https://doi.org/10.1016/j.ajem.2015.01.057.
    Pubmed CrossRef

Article

Case Report

J Korean Dysphagia Soc 2022; 12(2): 143-147

Published online July 30, 2022 https://doi.org/10.34160/jkds.2022.12.2.009

Copyright © The Korean Dysphagia Society.

Dysphagia Aortica Initially Misdiagnosed as Poststroke Dysphagia: A Case Report

InHyuk Suh, M.D., Sangpil Son, M.D., Jong Keun Kim, M.D., Jong Youb Lim, M.D., Ph.D.

Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea

Correspondence to:Jong Youb Lim, Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea
Tel: +82-42-611-3631, Fax: +82-42-611-3633, E-mail: jylimmd@eulji.ac.kr

Received: December 10, 2021; Revised: December 13, 2021; Accepted: March 24, 2022

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dysphagia aortica is a rare form of mechanical dysphagia characterized by extrinsic compression of the esophagus by the aorta. A 69-year-old male reported experiencing swallowing difficulties for five months, along with nausea, abdominal discomfort, weight loss, and severe reflux. Considering his age and a medical history of hypertension and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. However, brain magnetic resonance imaging revealed no evidence of acute or subacute stroke. Further evaluation was achieved via enhanced chest computed tomography to locate the focus of the systemic inflammation. A thoracic aortic aneurysm about 8.7×5.0 cm in size, with signs of impending rupture, was observed. This case reinforces that a high possibility for dysphagia aortica should be considered under conditions of unclear etiology of dysphagia but the presence of associated symptoms, such as progressive intolerance to solids and ultimately to liquids, weight loss, and nausea.

Keywords: Deglutition disorders, Dysphagia aortica, Esophageal dysphagia, Aortic aneurysm

INTRODUCTION

Dysphagia, which is classified as oropharyngeal or esophageal dysphagia according to the involved phase of swallowing, can result from a wide variety of possible causes, including neuromuscular, mechanical, and functional conditions1. The most common cause of neuromuscular dysphagia is stroke, which is the leading cause of oropharyngeal dysphagia. Dysphagia aortica, which is caused by extrinsic compression of the esophagus by the aorta, is a rare form of me-chanical dysphagia2. As dysphagia can lead to crucial complications, such as malnutrition, pneumonia, or airway obstruction, its cause should be diagnosed correctly3. This report presents a case of dysphagia aortica that was initially suspected as poststroke dysphagia.

CASE REPORT

A 69-year-old male with hypertension and diabetes mellitus visited the outpatient department of rehabilitation medicine because of swallowing difficulty. The symptom started five months ago, along with nausea and abdominal discomfort. He first visited the gastroenterology department, but there were no abnormal findings in both endoscopy and abdominal computed tomography. The symptom worsened, with significant malnutrition and weight loss of more than 10 kg in those five months. Further evaluation, such as thyroid ultrasonography and fine-needle aspiration biopsy, was conducted in the endocrinology department to distinguish other potential causes of weight loss, but there were no definite abnormal findings. He also visited the psychiatry department to evaluate possible psychiatric causes. Antidepressants were prescribed for a diagnosis of major depressive disorder. However, the symptom was still aggravated, even after the patient took antidepressants for more than one month. Lastly, he visited the outpatient department of rehabilitation medicine and the neurology department. He had been taking aspirin and clopidogrel from the neurology outpatient department since he had vertigo and was diagnosed with intracranial vertebral artery stenosis by brain magnetic resonance angiography (MRA) four years ago. At this moment, he could hardly swallow anything, including thin and thick liquids. Whenever he succeeded in swallowing, vomiting would follow. He described the feeling of having food stuck in the suprasternal notch and severe reflux after swallowing. Regarding his age and medical history of hypertension, diabetes mellitus, and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. He was admitted to the neurology department for evaluation of stroke.

Videofluoroscopic swallowing study (VFSS) was performed upon admission. The results were as follows: supraglottic penetration during liquid drinking with a cup or straw, oral transit time of 1.24 s, delayed pharyngeal transit time of 1.02 s, increased vallecular and pyriform residue, and decreased laryngeal elevation of 1.1 cm. Additionally, in the esophageal phase, delayed emptying of the esophagus, food reflux, and esophageal dilatation were observed.(Fig. 1) Oropharyngeal dysphagia combined with esophageal dysphagia was therefore suggested. For evaluation of stroke, brain magnetic resonance imaging including diffusion-weighted imaging and angiography was done; however, there was no evidence of acute or subacute stroke and no definite change of intracranial vertebral artery stenosis compared to the previously taken brain MRA. Laryngoscopy was performed to evaluate the anatomical structure and there were no abnormal findings.

Figure 1. Videofluoroscopic swallowing study findings. The arrow shows extrinsic compression of the esophagus by the thoracic aortic aneurysm.

At the time of admission, laboratory examination showed a white blood cell count of 6,230/mm3 (normal range: 3,800–10,500/mm3) and a C-reactive protein (CRP) level of 20.78 mg/dL (normal range: 0–0.5 mg/dL). A simple chest radiograph showed no definite evidence of active consolidation in both lung fields, and urine analysis was clear. He had no symptoms other than swallowing difficulty that implied any cause of systemic inflammation. Two days after performing VFSS, further radiologic evaluation was conducted with enhanced chest computed tomography to identify the focus of the systemic inflammation. A thoracic aortic aneurysm sized about 8.7×5.0 cm with the progression of deep ulcerating atheroma suggesting impending rupture was seen. On the axial view, the enhanced upper esophagus with residual barium implied near complete obstruction,(Fig. 2A) and a thoracic aortic aneurysm was compressing the thoracic part of the esophagus and was making it hardly visible below the upper esophagus.(Fig. 2B, C) The patient was transferred to the chest surgery department, and thoracic endovascular aortic repair (TEVAR) was done urgently.

Figure 2. Enhanced chest computed tomography findings. (A) The arrow shows the enhanced upper esophagus with residual barium which implies near complete obstruction by the thoracic aortic aneurysm. (B) The black arrow shows the hardly visible thoracic part of the esophagus compressed by the thoracic aortic aneurysm (white arrow). (C) The coronal view shows the dilated upper esophagus (white short arrow) and thoracic aortic aneurysm (white arrow) compressing the thoracic part of the esophagus.

Three weeks after the operation the patient was transferred to the general ward, and esophagography was performed.(Fig. 3) There was no definite evidence of contrast leakage and oral feeding was initiated with a small amount of puree diet. Gradually, the patient’s diet was altered to a regular diet.

Figure 3. Esophagography findings. No definite evidence of contrast leakage is identified.

DISCUSSION

Causes of dysphagia vary across the world, and various diagnostic methods have been established, such as VFSS, fiberoptic endoscopic evaluation of swallowing, esophagogastroduodenoscopy, esophageal manometry, and chest computed tomography4. Selection of proper diagnostic methods is needed for efficacy. In rehabilitation medicine, VFSS is used as an initial evaluation tool of dysphagia. Poststroke dysphagia is the leading cause of oropharyngeal dysphagia, especially in patients with risk factors, such as old age, hypertension, diabetes mellitus, and arrhythmia. Early diagnosis of stroke is important for acute management. However, in this case, during evaluation to find the presence of newly developed stroke, dysphagia aortica was initially suspected as poststroke dysphagia. Diagnosis of impending aortic rupture was done after initial evaluation.

There is no gold standard diagnostic method for dysphagia aortica5. If there are associated symptoms, such as progressive intolerance to solids and ultimately liquids, weight loss, nausea, and vomiting, dysphagia aortica should be considered2,6. In this case, the patient had these symptoms in addition to esophageal phase abnormalities found by VFSS, such as delayed emptying of the esophagus, food reflux, and esophageal dilatation. Along with esophageal phase abnormalities, dysphagia aortica has an oropharyngeal component. Unilateral vocal cord palsy occurs if the left recurrent laryngeal nerve is compromised at the aortic arch and it increases the risk of aspiration by impairing epiglottic tilting, closure of the vocal folds, and laryngeal elevation7. The association of suggestive symptoms, along with the results of VFSS, led to a high index of suspicion. Further diagnostic methods, such as chest computed tomography, esophagogastroduodenoscopy, and esophageal manometry, might be considered for evaluation of non-neurogenic dysphagia.

Chest computed tomography can show the enlargement of the aortic arch, tortuous dilation of the aorta, or direct compression of the esophagus by an aortic aneurysm5. Esophagogastroduodenoscopy may reveal external compression of the esophagus and stenosis of the lower esophagus with proximal dilatation by a tortuous aorta, and this can be replaced with a barium swallow where esophageal wall indentation and partial esophageal obstruction by a pulsatile mass are present8,9. Esophageal manometry may find a focal high-pressure band with superimposed pulsations10. CRP can be elevated in patients with dysphagia aortica indicating vessel wall inflammation. There is a systematic review that elevated CRP levels indicate increased mortality in aortic dissection due to the inflammatory process within the wall making the damaged aorta more prone to redissection and rupture11.

Upon diagnosis with dysphagia aortica, a treatment plan is established in accordance with the severity of symptoms. Mild cases can be treated conservatively using diet modification and management of underlying diseases12. In severe cases, surgery should be considered, such as transposition of the distal esophagus, separation of the esophagus from the aorta, esophagomyotomy, esophageal stenting, and aortic aneurysm repair5. Patients with severe symptoms who cannot undergo surgical intervention can be symptomatically managed with insertion of a percutaneous endoscopic gastrostomy tube13.

Dysphagia aortica is a rare form of dysphagia, but misdiagnosis can lead to devastating results14. We report one of the few cases of dysphagia aortica successfully treated with TEVAR. However, even in this case, earlier diagnosis could have led to earlier surgical intervention for the aortic aneurysm, and a better prognosis could have been made. Our case reinforces that a high index of suspicion for dysphagia aortica should be maintained when the etiology of dysphagia is unclear and associated symptoms are present, such as progressive intolerance to solids and ultimately liquids, weight loss, and nausea.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

AUTHORS’ CONTRIBUTIONS

IS was a major contributor in writing the manuscript. JYL was involved in drafting the manuscript and revising it for intellectual content. SS and JKK analyzed and interpreted the patient data regarding dysphagia. All authors read and approved the final manuscript.

Fig 1.

Figure 1.Videofluoroscopic swallowing study findings. The arrow shows extrinsic compression of the esophagus by the thoracic aortic aneurysm.
Journal of the Korean Dysphagia Society 2022; 12: 143-147https://doi.org/10.34160/jkds.2022.12.2.009

Fig 2.

Figure 2.Enhanced chest computed tomography findings. (A) The arrow shows the enhanced upper esophagus with residual barium which implies near complete obstruction by the thoracic aortic aneurysm. (B) The black arrow shows the hardly visible thoracic part of the esophagus compressed by the thoracic aortic aneurysm (white arrow). (C) The coronal view shows the dilated upper esophagus (white short arrow) and thoracic aortic aneurysm (white arrow) compressing the thoracic part of the esophagus.
Journal of the Korean Dysphagia Society 2022; 12: 143-147https://doi.org/10.34160/jkds.2022.12.2.009

Fig 3.

Figure 3.Esophagography findings. No definite evidence of contrast leakage is identified.
Journal of the Korean Dysphagia Society 2022; 12: 143-147https://doi.org/10.34160/jkds.2022.12.2.009

References

  1. Choi SHJ, Yang GK, Gagnon J. Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement. J Vasc Surg Cases Innov Tech 2019;5:501-5. https://doi.org/10.1016/j.jvscit.2019.08.008.
    Pubmed KoreaMed CrossRef
  2. Kim JH, Jang SW, Kim DB, Lee HJ, Kim JG, Kwon BJ, et al. A patient with dysphagia due to an aortic aneurysm. Korean Circ J 2009;39:258-60. https://doi.org/10.4070/kcj.2009.39.6.258.
    Pubmed KoreaMed CrossRef
  3. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Rep 2013;1:187-96. https://doi.org/10.1007/s40141-013-0017-y.
    Pubmed KoreaMed CrossRef
  4. Abdel Jalil AA, Katzka DA, Castell DO. Approach to the patient with dysphagia. Am J Med 2015;128:1138.e17-23. https://doi.org/10.1016/j.amjmed.2015.04.026.
    Pubmed CrossRef
  5. Chan YH, Hung CY, Shieh TY, Wang HY, Chang CW, Shih SC, et al. Nonaneurysmatic dysphagia aortica in the elderly: three case reports and literature review. Int J Gerontol 2016;10:52-5. https://doi.org/10.1016/j.ijge.2014.12.003.
    CrossRef
  6. Hilliard AA, Murali NS, Keller AS. Dysphagia aortica. Ann Intern Med 2005;142:230-1. https://doi.org/10.7326/0003-4819-142-3-200502010-00031.
    Pubmed CrossRef
  7. Lee SI, Pyun SB, Jang DH. Dysphagia and hoarseness associated with painless aortic dissection: a rare case of cardiovocal syndrome. Dysphagia 2006;21:129-32. https://doi.org/10.1007/s00455-006-9015-x.
    Pubmed CrossRef
  8. Coelho-Prabhu N, Baron TH. Dysphagia and weight loss in an elderly person. Dysphagia aortica. Gastroenterology 2009;137:e1-2. https://doi.org/10.1053/j.gastro.2009.02.011.
    Pubmed CrossRef
  9. Mouawad NJ, Ahluwalia GS. Dysphagia in the aging cardiovascular patient. J Thorac Dis 2017;9:E1005-8. https://doi.org/10.21037/jtd.2017.10.59.
    Pubmed KoreaMed CrossRef
  10. Park SY, Lee JH, Cho SB, Lee WS, Park CH, Kim HS, et al. Aggravation of dysphagia aortica after wearing the abdominal binder. J Neurogastroenterol Motil 2010;16:323-6. https://doi.org/10.5056/jnm.2010.16.3.323.
    Pubmed KoreaMed CrossRef
  11. Vrsalović M, Vrsalović Presečki A. Admission C-reactive protein and outcomes in acute aortic dissection: a systematic review. Croat Med J 2019;60:309-15. https://doi.org/10.3325/cmj.2019.60.309.
    Pubmed KoreaMed CrossRef
  12. Karavelioğlu Y, Kalçik M, Yetim M, Sarak T, Bekar L, Doğan T. A rare cause of dysphagia and weight loss in a Nonagenarian with hypertension: dysphagia aortica. J Am Geriatr Soc 2015;63:1488-9. https://doi.org/10.1111/jgs.13544.
    Pubmed CrossRef
  13. Badila E, Bartos D, Balahura C, Daraban AM. A rare cause of dysphagia - dysphagia aortica - complicated with intravascular disseminated coagulopathy. Maedica (Bucur) 2014;9:83-7.
    Pubmed KoreaMed
  14. Liao CY, Huang SC, Wang YC, Chin HK, Tsai CC, Ben RJ, et al. Dysphagia aortica: a fatal delay in diagnosis. Am J Emerg Med 2015;33:1117.e3-5. https://doi.org/10.1016/j.ajem.2015.01.057.
    Pubmed CrossRef

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