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1 From the Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Holland
An aberrant right subclavian artery can occasionally give rise to clinical manifestations. Dysphagia as a symptom has long been known; however, in children, serious respiratory distress may occur, even in the absence of dysphagia.
The retro-esophageal course of the right subclavian artery does not in itself account satisfactorily for the tracheo-esophageal compression, which can only occur if the carotid arteries present a common origin from the aortic arch or if they are in close approximation. This belief is based on a personal observation as well as a review of 292 necropsy and surgical cases, collected from 76 publications in the literature.
The diagnosis was made from the esophagrams in 50 cases. Clinical signs of tracheoesophageal compression were found in 9. Two children presented with respiratory distress, necessitating surgical intervention in one of them. Dysphagia was noted in 7 cases, all adults.
The indentations in the barium-filled esophagus caused by the aberrant vessel are discussed. Attention is drawn to the importance of the left anterior oblique esophagram for distinguishing a filling defect caused by an aberrant right subclavian artery from one produced by the left main bronchus. In elderly patients, the posteroanterior esophagram is of greater value in establishing the diagnosis.
The roentgenologic characteristics of tracheo-esophageal compression produced by the aberrant vessel are demonstrated in the lateral esophagram (Fig. 6) of a 2 year old girl who was operated upon because of serious respiratory distress.
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