Unusual Cause of Chest Pain and Dysphagia in a Middle-Aged Woman with Right Aortic Arch and Aberrant Left Subclavian Artery

The aberrant subclavian artery is an uncommon congenital anomaly in the aortic arch, which may have a variety of presentations, including dysphagia, dyspnea, and chest pain, depending on the anatomical site of the aberrant vessel. Treatment is individualized, and surgical management is only considered in symptomatic patients. Dysphagia is one of the most important symptoms for which clinicians should consider surgery. Here, we present an interesting case of a 49-year-old woman who first came with the presentation of acute coronary syndrome and underwent coronary angiography, which showed no sign of significant lesions but revealed a probable abnormal left subclavian artery and right aortic arch. The patient refused further evaluation at that time; however, she came back after three years with progressive chest pain and dysphagia as a new complaint. After a step-by-step work-up for the patient's dysphagia, including barium swallow and upper endoscopy, chest CT angiography was performed that demonstrated a left aberrant subclavian artery as the potential cause of her complaints. After the diagnosis became clear, surgical ligation of the aberrant left subclavian artery and release of the vascular ring around the esophagus were done for the patient, as well as anastomosis of the left carotid artery to the left subclavian artery by saphenous vein graft interposition.