DYSPHAGIA LUSORIA: PRIKAZ PACIJENTA SA ABERANTNOM DESNOM POTKLJUČNOM ARTERIJOM I ZAJEDNIČKIM STABLOM KAROTIDNIH ARTERIJA
Sažetak
Aberantna desna arterija subklavija (ADAS) predstavlja retku vaskularnu anomaliju. Još se ređe dešava da bude udružena sa disfagijom i zajedničkim stablom karotidnih arterija ‒ truncus bicaroticus (TB). Bejford je 1794. godine opisao ADAS i nazvao je tu pojavu arteria lusoria, a ovaj tip disfagije dysphagia lusoria. Infundibularno proširenje na odstupu ADAS-a prvi je opisao Komerel 1936. godine, pa se naziva Komerelov divertikulum.
Kod šezdesetdevetogodišnjeg pacijenta M. D. potvrđene su disfagija i promuklost. Dva meseca pre pregleda došlo je do gubitka težine (9,5 kg). Ezofagoskopski je uočena spoljna kompresija na zadnjem zidu srednje trećine jednjaka. Pregled grudnog koša urađen pomoću višeslojne kompjuterizovane tomografije (engl. Multi-slice Computed Tomography), kao najpouzdanijeg neinvazivnog dijagnostičkog sredstva, ukazao je na ADAS i Komerelov divertikulum sa TB-om.
Prisustvo ADAS-a je najčešće asimptomatsko i slučajno se otkriva prilikom pregleda i obdukcija. Disfagične tegobe praćene gubitkom telesne težine (ako su prisutne) potiču od spoljne kompresije ADAS-a na ezofagus, dok se promuklost javlja u okviru Ortnerovog kardiovokalnog sindroma. Bolesniku je dat savet da se uputi na operativno lečenje ako dođe do pogoršanja disfagičnih tegoba. Preporučeno mu je da dotad jede češće u toku dana, da zalogaji budu mali, kao i da koristi inhibitore protonske pumpe.
Reference
Amante S, Sousa R, Amaral R. Arteria Lusoria: An Uncommon Cause of Dysphagia. Acta Med Port 2019. [CrossRef] [PubMed]
Andersen K, Hoff R, Silas D. Dysphagia Lusoria. J Am Osteopath Assoc 2020;120(12):941. [CrossRef] [PubMed]
Bayford D. An account of a singular case of obstructed deglutition. Mem Med Soc Lond. 1794; 2:271–82.
Chandrupatla M, Raviteja P, Motwani R. Arteria lusoria with patent foramen ovale: clinical and embryological significance with literature review. Surg Radiol Anat 2023; 45(7):807-11. [CrossRef] [PubMed]
Epperson MV, Howell R. Dysphagia lusoria: problem or incidentaloma? Curr Opin Otolaryngol Head Neck Surg 2019;27(6):448-52. [CrossRef] [PubMed]
Faraj C, Essetti S, Maslouhi K, Allali N, El Haddad S, Chat L. Incidental Finding of Arteria Lusoria. Glob Pediatr Health 2024;11:2333794X241273210. [CrossRef] [PubMed]
Fetterolf G, Norris G. The anatomical explanation of paralysis of left recurrent laryngeal nerve found in certain cases of mitral stenosis. Am J Med Sci. 1911; 141:625–38. [CrossRef]
Gailloud, P. Vertebral arteria lusoria—Hyrtl’s original description (1859), case illustration, and literature analysis. Surg Radiol Anat 2024; 46: 1633–42. [CrossRef] [PubMed]
Hasina Laingonirina DH, Rakotozafindrabe ALR, Razafindrazoto CI, Rajaonarison LHNON, Randriamifidy NH, Rabenjanahary TH, Razafimahefa SH, Ramanampamonjy RM. Arteria lusoria: A rare cause of chronic dysphagia. Clin Case Rep. 2021 Oct 4;9(10):e04895. [CrossRef] [PubMed]
Hunauld PM. Examen de quelques parties du`n singe. Hystoire de l`Academie Royale de Sciences 1735;vol.2:516–523.
Jakobsen SS, Frøkjaer JB, Larsen AC. Arteria lusoria: a trick of nature. Scand J Gastroenterol 2021;56(5):621-3. [CrossRef] [PubMed]
Jalaie H, Grommes J, Sailer A, Greiner A, Binnembosel M, Kalder J, Schrink GW, Jacobs MJ. Treatment of symptomatic aberrant subclavian arteries. Europ J Vasc Endovas Surg 2014; 48(5):521–6. [CrossRef] [PubMed]
Kommerell B. Verlagerung des osophagus durch eine abnorm verlaufende arteria subclavia dextra (arteria lusoria). Fortschr Geb Rontgenstr Nuklearmed 1936; 54:590–5. [CrossRef] [PubMed]
Lacout A, Khalil A, Figl A, Liloku R, Marcy PY. Vertebral arteria lusoria: A life-threatening condition for esophageal surgery. Surg Radiol Anat 2012; 34:381–3. [CrossRef] [PubMed]
Mashru D, Murali V, Pawar P, Bharavi N, Shinde RS. Arteria Lusoria: a Menace in Robotic Esophagectomy. Indian J Surg Oncol 2023;14(4):904-6. [CrossRef] [PubMed]
Mrochek AG, Kabak SL, Haidzel IK, Melnichenko YM, Kalenchic TI. Coexistence an aberrant right subclavian artery with other congenital anomalies: case report and review of the literature. Surg Radiol Anat 2019;41(8):963-7. [CrossRef] [PubMed]
Najar MM, Ilyas M, Wani GM, Ahmad Z, Sheikh WA. Truncus bicaroticus and arteria lusoria-a rare combination of aortic arch anomalies. Indian J Thorac Cardiovasc Surg 2019;35(1):121-3. [CrossRef] [PubMed]
Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat 2015; 31:319–23. [CrossRef] [PubMed]
Nedelcu AH, Lupu A, Moraru MC, Tarniceriu CC, Stan CI, Partene Vicoleanu SA, Haliciu AM, Statescu G, Ursaru M, Danielescu C, Ioniuc I, Tepordei RT, Lupu VV. Morphological Aspects of the Aberrant Right Subclavian Artery-A Systematic Review of the Literature. J Pers Med 2024;14(4):335. [CrossRef] [PubMed]
Norris CR, Wilson CA, Lin MC. Truncus Bicaroticus With Arteria Lusoria: A Rare Combination of Aortic Root Anatomy Complicating Cardiac Catheterization. Fed Pract 2021;38(2):84-8. [CrossRef] [PubMed]
Ortner N. Recurrenslahmung bei mitral stenose. Wien Klin Wochenschr 1897; 10:753–5. [CrossRef] [PubMed]
Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. ScientificWorldJournal 2014;2014:292734. [CrossRef] [PubMed]
Subramanian PC, Chidanandaswamy N, Soundararajan R, Bhujade H, Prabhakar N. An Aberrant Right Subclavian Artery-Esophageal Fistula-A Fatal Complication of a Common Anomaly: A Case Report and Review of Literature. Indian J Radiol Imaging 2022;33(1):117-20. [CrossRef] [PubMed]
Valdivielso Cortázar E, Guerro Moya A, Alonso Aguirre P. Massive upper gastrointestinal bleeding secondary to an esophago-arterial fistula (arteria lusoria). Rev Esp Enferm Dig 2021;113(9):687. [CrossRef] [PubMed]
Work WP. Unusual position of the right recurrent laryngeal nerve. Ann otol Rhinol Laryngol 1941; 50:769–75. [CrossRef]
