Endgames Spot Diagnosis

Mild dysphagia and globus sensation in an older man

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2106 (Published 18 May 2017) Cite this as: BMJ 2017;357:j2106
  1. Subramanian Nachiappan, radiology registrar,
  2. David C Howlett, radiology consultant
  1. Eastbourne District General Hospital, Eastbourne, UK
  1. Correspondence to s.nachiappan{at}nhs.net

A 72 year old man presented with a three to four month history of non-progressive difficulty in swallowing and a globus sensation at the cervicothoracic level. Nasoendoscopy was normal. A chest radiograph was performed (fig 1). What does it show?

Fig 1 Chest radiograph

Answer

The radiograph shows a right sided aortic arch (fig 2, arrows) and unfolding of the ascending aorta: an example of a vascular ring.

Fig 2 Chest radiograph. White arrows show right sided aortic arch

Discussion

Aortic arch abnormalities, also known as vascular rings, are often diagnosed in infancy or …

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