Dysphagia Lusoria: An Elusive Case of Dysphagia Caused by a Rare Embryonic Vascular Sling

Dysphagia lusoria is an uncommon cause of dysphagia with an increasing incidence with age. It is unknown why individuals with dysphagia lusoria typically remain asymptomatic until older adulthood, but some theorize that it could be related to physiologic and anatomical changes that occur with the aging process, such as increased esophageal rigidity and stiffening of vascular walls with atherosclerosis, that make the compression from these congenital aberrations more impactful. While uncommon, it is also likely underrecognized due to its being diagnostically challenging to identify. Moreover, dysphagia may be inappropriately ascribed to being a normal part of aging or ascribed to other coexisting comorbidities when in actuality the cause is multifactorial. Given that different causes of dysphagia warrant distinct interventions, it is important for clinicians to have awareness of unusual or uncommon causes of dysphagia to allow for early detection and intervention to prevent the significant morbidity and mortality that can result. We present a case of dysphagia lusoria in a medically complex older adult male patient admitted for otherwise non-medical care. Due to recognition of the need for multidisciplinary evaluation of complex dysphagia, a timely diagnosis was made, allowing for early intervention with nonsurgical management. The case highlights the need for an integrated approach with close follow-up by the surgical team and speech-language pathology as part of the pathway to ensure best management practice prior to the development of complications.