CASE REPORT
A 70-year-old woman presented to a consultation for dysphagia evolving for more than 10 years, mainly on solid foods. There was no obvious blockage on swallowing. The general condition was still preserved. Moreover, the dysphagia was associated with spontaneous chest pain, which was favored by swallowing. There was no vomiting or transit disorder. The patient had a history of intestinal amoebiasis treated in 2010 and chronic smoking weaned in 2014 (10 pack-years). There was no personal history of alcoholism or family history of systemic disease.
On clinical examination, the patient was conscious, apyretic, blood pressure was 130/80mmHg. She had a performance status score at 0 and a body mass index 18 Kg/m2. The respiratory examination was normal. The cardiovascular examination did not show any particular abnormally, especially vascular murmurs. There were no palpable peripheral nodes.
Biological examinations such as complete blood count, erythrocyte sedimentation rate, C-reactive protein, fasting glycemia, creatinine, urea, serum protein electrophoresis, serum calcium, TSH, free T3 and T4 were normal. Human immunodeficiency virus serology was negative.
Upper gastrointestinal (GI) endoscopy did not reveal any abnormality except for a slightly angled esophagus 25 cm from the dental arch. Step biopsy for eosinophilic esophagitis was normal. Chest X-ray came back normal. Chest and abdominal CT scan revealed a vascular image in favor of an aberrant right subclavian artery (Figure 1 and 2) and a left incidentaloma.