1/108. Ossification of the cervical anterior longitudinal ligament contributing to dysphagia. Case report.The authors evaluated the clinical, radiological, and surgical management of ossification of the anterior longitudinal ligament (OALL) that contributed to dysphagia in a patient with simultaneous cervical ossification of the posterior longitudinal ligament (OPLL). A 57-year-old man presented with increasing dysphagia and moderate myelopathy. Imaging studies, including esophagoscopy, revealed marked esophageal compression due to OALL that extended between the C2-5 levels and significant C5-7 OPLL that compressed the distal cervical spinal cord. The use of rongeurs and a high-speed drill facilitated excision of the C2-5 OALL mass, and a routine anterior corpectomy with fusion was performed at the C5-7 level. Postoperatively, the patient's dysphagia and symptoms of myelopathy immediately resolved. The strut graft became fully fused 3 months postoperatively, as demonstrated on dynamic x-ray films, and the patient has remained asymptomatic 4 months postoperatively. patients with dysphagia and coexisting myelopathy benefit from simultaneous surgery for resection of OALL and OPLL masses.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/108. Vascular rings of the thoracic aorta in adults.Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in infants and children. Few reports document symptomatic vascular rings in adults, and most have emphasized dysphagia as the predominant symptom. We present the case of a 36-year-old white male with a double aortic arch and progressive dyspnea on exertion. This led us to review previous reports of vascular rings in adults. Criteria for review consisted of anatomically complete vascular rings of the aortic arch in adults age 18 years or older. We identified 25 prior cases for review and included our recent patient. The most common vascular ring anomalies in our review of adults is double aortic arch (n = 12; 46%) followed by right aortic arch with aberrant left subclavian artery and ligamentum arteriosum (n = 8; 30%). Of 24 patients (66%), 16 were symptomatic. Reported symptoms involving the respiratory tract (n = 10 of 24; 42%) included dyspnea on exertion (n = 5), bronchitis (n = 2), recurrent pneumonia, stridor, and unspecified respiratory ailment (n = 1 each). Dysphagia was less common, occurring in eight patients (33%). Previously proposed mechanisms for respiratory tract symptoms include tracheomalacia, static or dynamic compression of the airways, intravascular volume infusion, and aspiration. We also propose exercise-induced dilatation of the aortic arch and age-dependent changes in thoracic compliance as potential mechanisms of dyspnea.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
3/108. Severe hypopharyngeal dysphagia in a patient on chronic steroid treatment.A 44-year-old Caucasian male who had been on long-term steroid treatment for an unspecified collagen disease was referred to our Unit because of fever, severe hypopharyngeal dysphagia, night sweats and evidence of marked superior vena cava compression. Extrapulmonary disseminated tuberculosis also involving bone and liver was eventually diagnosed and proven by means of specific polymerase chain reaction assay. Antimycobacterial treatment, which led to a dramatic improvement within two months, was protracted for 18 months until the complete return to normal of both clinical and laboratory findings.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/108. Surgical treatment of vascular ring including right cervical aortic arch.Cervical aortic arch is a developmental entity consisting of persistence of the right or left third branchial arch and regression of the fourth branchial arches. In most cases, the aorta is redundant and crosses behind the esophagus to the opposite side. In the presence of an aberrant subclavian artery contralateral to the side of the aortic arch and a ligamentum arteriosum, a vascular ring is formed around the trachea and esophagus. Two young patients with right-sided cervical aortic arch, aberrant left subclavian artery, and ligamentum arteriosum presented with dysphagia and exertional dyspnea. In one patient, through a left thoracotomy, the ligamentum arteriosum was divided, and the trachea and esophagus were dissected thoroughly above and below the level of the ring. In addition, the aberrant left subclavian artery was divided at its origin from a large diverticulum and implanted into the left common carotid artery; the aortic diverticulum was resected. In the other patient, who had associated 22q11 chromosomal deletion, in addition to left-sided compression of the trachea and esophagus, there was additional marked compression of the right anterolateral trachea by the redundant ascending aorta. Through a median sternotomy, the ligamentum arteriosum was divided, and the trachea and esophagus were widely mobilized; an additional aortopexy of the ascending aorta to the right of the sternum resulted in the absence of tracheal compression. The cases of the two reported patients illustrate the clinical variability of vascular ring, including a right cervical aortic arch and the consequently versatile surgical approach that is needed to successfully address this combination of vascular anomalies.- - - - - - - - - - ranking = 3keywords = compression (Clic here for more details about this article) |
5/108. Double aortic arch: diagnosis missed for 29 years.Double aortic arch is a rare vascular anomaly which causes tracheal and esophageal compression usually in the first months of life. Typical symptoms in the early childhood should lead to prompt diagnosis and surgical treatment of this malformation. In adults this anomaly is extremely rare. A case of a severely 29-year-old symptomatic woman is presented. Despite characteristic symptoms, the diagnosis was missed during childhood. The importance of different diagnostic procedures and operative therapy is discussed. Preoperative angiography can be replaced by the less invasive magnetic imaging and computed tomography. Surgical operation should also be performed in oligosymptomatic patients to prevent late complications.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
6/108. Dysphagia in a patient with giant osteophytes: case presentation and review of the literature.A patient with increasing dysphagia due to external bone compression of the oesophagus is presented. Radiographic evaluation revealed the underlying condition to be a diffuse idiopathic skeletal hyperostosis with exuberant and bumpy change within the anterior longitudinal ligament.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
7/108. Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans.BACKGROUND: Cervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients. methods: A 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL, was treated with a cervical laminectomy followed by anterior DISH resection. On the other hand, an 80-year-old male with asymptomatic DISH but moderate myelopathy (Nurick Grade III) secondary to OPLL required only a cervical laminectomy. RESULTS: In the first patient, dysphagia resolved within 3 months of surgery, while in the second individual, myelopathy improved to Nurick Grade I (mild myelopathy) within 6 months postoperatively. Improvement in both patients was maintained 1 year after surgery. CONCLUSIONS: While DISH and OPLL may coexist in geriatric patients, only those with dysphagia should undergo DISH resection, while others demonstrating myelopathy should have laminectomy alone.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
8/108. Dysphagia secondary to iatrogenic hyoid bone fracture.Dysphagia as a result of an iatrogenic fracture of the hyoid bone is presented. review of the world literature reveals this phenomena to be previously unreported following surgery.- - - - - - - - - - ranking = 0.63715982649769keywords = fracture (Clic here for more details about this article) |
9/108. Dysphagia lusoria: a case study.Dysphagia lusoria is described in the literature as difficulty swallowing because of a "jest of nature." The "jest of nature" is a birth defect encompassing any aortic root vascular anomaly that causes esophageal dysphagia. persons with dysphagia lusoria can be categorized according to their specific subclavian anomaly (ie, depending on the presence of an aneurysm, occlusive disease, or esophageal compression). All patients with this anomaly have an aberrant subclavian artery in a transposed position that courses posterior to the esophagus. The operative approach to repair this condition has been controversial. An extrathoracic approach is documented as superior to a repair involving thoracotomy because there is decreased rate of complications that may be associated with a thoracotomy and greater visibility of the subclavian and carotid artery. This case study describes a 25-year-old woman with dysphagia lusoria related to an aberrant right subclavian artery. The report includes a literature review and describes the perioperative approach and nursing care. The use of the preadmission and same-day admission services are supported as is an extrathoracic surgical approach. At follow-up this patient reported no symptoms of dysphagia and showed no evidence of esophageal compression confirming that persons with symptomatic dysphagia lusoria can be managed with positive long-term results.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
10/108. Dysphagia and thoracoabdominal aneurysm.Two elderly patients who presented with gradually progressive dysphagia are described. Investigations excluded an intraluminal obstruction and showed extrinsic compression of the oesophagus by an aneurysmal aorta. Surgery was not performed and they were successfully managed with a liquid diet.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
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