**7. Conclusion**

The diagnostic modalities available to visualize an arteria lusoria include barium esophagogram, computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA), endoscopy and endoscopic ultrasound. New advances in CT technology allow even small vascular structures to be visualized in detail. Multidetector computed tomography (MDCTA) is now an established diagnostic test in the evaluation of many vascular

82 Epidemiology of Communicable and Non-Communicable Diseases - Attributes of Lifestyle and Nature on Humankind

Barium contrast examination of the esophagus shows a characteristic, extrinsic, smooth diagonal impression at the level of the third and fourth dorsal vertebra. Lateral or oblique views show the extrinsic impression to be posterior, and in case of arteria lusoria, just above the level of the aortic arch. As dysphagia occurs frequently with ingestion of solid foods,

Digital subtraction angiography gives valuable information regarding AL. It is an invasive procedure and, in contrast to MDCT, has the disadvantage in showing extravascular structures such as the esophagus. It has also been shown that the effective radiation doses in MDCT angiography studies are moderate and even lower than those associated with DSA in a

CT or MRI (magnetic resonance imaging) angiography has replaced conventional angiography and is the gold standard for the diagnosis. It not only confirms the diagnosis but also helps to exclude aneurysm of the aorta or other associated anomalies and to plan the

MRI has the advantage of being a noninvasive procedure and the patient is spared the potential risk of intravenous contrast agents. MRI is not as useful as MDCT due to the generation of respiratory and cardiac motion artifacts. Also it is not a preferred method due to its cost and prolonged scan time. Although MR angiography may reveal the presence of a vascular anomaly, the information regarding nonvascular mediastinal structures

Endoscopy may reveal pulsatile, shelf-like extrinsic compression in the posterior wall of the esophagus, with intact mucosa. Such an area of narrowing is usually located between 20 and

Endoscopic ultrasound (EUS) can identify an arteria lusoria, as it lies close to the esophagus. EUS is regarded as the most accurate test for the evaluation of the esophageal wall and the surrounding structures, with the incorporation of Doppler technology in modern echoendo-

The combination of MDCT with 3D volume rendering images provides further advantages. These allow not only the depiction of the thoracic vascular anomalies but also more accurate assessment of the diameter, angle, and compressed area of the esophagus and the relationship between the AL with the esophagus and other mediastinal structures. In addition, MDCT is a noninvasive procedure, unlike DSA, and offers easier application and a shorter time require-

scopes allowing particularly accurate examination of adjacent vessels [10].

including a barium soaked bread bolus may improve localization of the defect [35].

diseases [35–39].

comparable patient group.

operation [36–39].

is insufficient [36–39].

24 cm from the mouth [7].

ment than DSA or MRA [36–39].

A familiarity with the anatomy of the some types of vascular anomalies is necessary for clinicians involved in many medical areas. Compression of adjacent structures by an arteria lusoria needs to be differentiated from other conditions presenting symptoms such as dysphagia, dyspnea, retrosternal pain, cough, and weight loss. The knowledge presented in this chapter will allow the best healthcare to be provided for patients.
