Correspondence

Aberrant Right Subclavian Artery and Dysphagia Lusoria

N Engl J Med 2002; 347:1532November 7, 2002

Article

To the Editor:

Kent and Poterucha (May 23 issue)1 present excellent angiographic images of an aberrant right subclavian artery, which was causing intermittent dysphagia. However, it is our opinion that angiography of the aorta could have been achieved noninvasively, with computed tomography (CT). Multislice CT and three-dimensional angiographic reconstruction, with the use of volume-rendering techniques, reveal this particular anomaly of the aortic arch elegantly (Figure 1Figure 1Multislice CT and Three-Dimensional Reconstruction of the Thoracic Aorta and Esophagus.). The advantage of this technique is that it provides a three-dimensional model showing the exact spatial relation of adjacent structures. Data pertaining to structures such as the esophagus can be saved and added to the angiographic model. This type of information is invaluable in surgical planning.

Gareth J. Morgan-Hughes, B.M., B.S.
Patrick E. Owens, M.D.
Carl A. Roobottom, B.M., B.S.
South West Cardiothoracic Centre, Plymouth PL6 8DH, United Kingdom
hughesgj@talk21.com

1 References

1. 1

   Kent PD, Poterucha TH. Aberrant right subclavian artery and dysphagia lusoria. N Engl J Med 2002;346:1637-1637
   Full Text | Web of Science | Medline

To the Editor:

The aberrant right subclavian artery is a common variant, with a prevalence of 2.9 percent.1 Although it is a delight to demonstrate, its discovery is often incidental. If investigation other than barium esophagography is necessary, magnetic resonance imaging will reveal the vessels, their origins and course, and their effect, if any, on the esophagus and trachea.

We disagree strongly with the authors' choice of imaging techniques. It is not acceptable to subject patients, especially if their symptoms are “mild and intermittent,” to radiation and to the risks associated with invasive procedures when there is a suitable alternative. The radiation exposure associated with thoracic CT and arch angiography as performed in this patient is equivalent to more than six times the annual background dose of radiation.2,3

The principle of “Primum non nocere” still exists.

Helena O'Dwyer, M.D.
Stephanie Ryan, M.D.
Colm Saidlear, B.Sc.
Children's University Hospital, Dublin 1, Ireland
stephanie.ryan@tsch.ie

3 References

1. 1

   Daseler EH, Anson BJ. Surgical anatomy of the subclavian artery and its branches. Surg Gynecol Obstet 1959;108:149-174
   Web of Science | Medline

2. 2

   McParland BJ. A study of patient radiation doses in interventional radiological procedures. Br J Radiol 1998;71:175-185
   Web of Science | Medline

3. 3

   Ruiz Cruces R, Garcia-Granados J, Diaz Romero FJ, Hernandez Armas J. Estimation of effective dose in some digital angiographic and interventional procedures. Br J Radiol 1998;71:42-47
   Web of Science | Medline