Unexpected finding in a man in his 50s with postprandial and exertional chest pain (2024)

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Volume 25 Issue 7 July 2024
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Margaret Doyle

Sidney Kimmel Medical College at Thomas Jefferson University

,

1025 Walnut St #100, Philadelphia, PA 19107

,

USA

Corresponding author. E-mail: mkd110@students.jefferson.edu

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Douglas Corsi

Sidney Kimmel Medical College at Thomas Jefferson University

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1025 Walnut St #100, Philadelphia, PA 19107

,

USA

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Brian Osler

Department of Medicine, Division of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University

,

Philadelphia, PA

,

USA

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European Heart Journal - Cardiovascular Imaging, Volume 25, Issue 7, July 2024, Page e186, https://doi.org/10.1093/ehjci/jeae034

Published:

31 January 2024

Article history

Published:

31 January 2024

Corrected and typeset:

10 February 2024

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    Margaret Doyle, Douglas Corsi, Brian Osler, Oleg (Alec) Vishnevsky, Unexpected finding in a man in his 50s with postprandial and exertional chest pain, European Heart Journal - Cardiovascular Imaging, Volume 25, Issue 7, July 2024, Page e186, https://doi.org/10.1093/ehjci/jeae034

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A 58-year-old male patient with a prior 4.0 cm ascending aortic aneurysm was evaluated for crescendo angina. Notably, symptoms included chest pain with exertion and while eating. He was eventually admitted for unstable angina. Troponins were negative. Normal biventricular function was seen on transthoracic echocardiogram. Electrocardiogram showed sinus rhythm with premature atrial contractions. Exercise stress myocardial perfusion imaging was normal. Coronary angiography showed minimal luminal irregularities. A computed tomography angiogram (CTA) demonstrated left-sided aortic arch with an anomalous right subclavian artery (Panel A) coursing posterior to the oesophagus with oesophageal compression (Panel B) consistent with arteria lusoria. This is further demonstrated on 3D reconstruction (Panel C). When associated with symptoms of indigestion and dysphagia, this entity is called dysphagia lusoria. This rare but important vascular abnormality occurs in 0.5–2.5% of individuals and can cause substernal chest pain, angina-like symptoms, and dysphagia. It is an unusual but important cause of chest pain syndromes.

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