Pediatric Dysphagia Lusoria: Identification on Videofluoroscopy

Videofluoroscopic swallow studies (VFSSs) are considered the gold standard for the evaluation of pediatric dysphagia; however, clinical protocols primarily focus on oropharyngeal function and airway protection, with limited attention to the esophageal phase. This practice overlooks esophageal contributions to feeding dysfunction and fails to identify underlying etiologies for swallow dysfunction, potentially prolonging ineffective intervention. This case report describes a pediatric patient who underwent an esophageal sweep during a follow-up VFSS, resulting in identification of a posterior esophageal compression. A computed tomography angiogram confirmed the vascular anomaly, recommending cardiac surgery that resulted in clinical improvement. In the absence of overt cardiac symptoms, referral to cardiology would have been unlikely without esophageal visualization. Despite adherence to evidence-based dysphagia management, swallow safety only improved after surgical correction. This case highlights the clinical value of incorporating esophageal screening during VFSSs when standard oropharyngeal evaluation fails to fully explain symptoms or suggests an underlying esophageal etiology. These findings underscore the need for speech-language pathologists to recognize esophageal contributions to feeding and swallowing disorders when patient outcomes fail to improve with standard care. Overall, a shift in clinical practice toward exploration of etiology for feeding disorders is pertinent to improve therapeutic outcomes.