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- airway obstruction
- imaging/CT MRI
- perception of asthma/breathlessness
- rare lung diseases
A 75-year-old Caucasian man presented with a 3-month history of progressive dyspnoea, unrelated to position, with an exercise tolerance of 100 m. He had experienced thrombolysis following an inferior myocardial infarction 8 years previously.
Initial diagnosis was cardiac dyspnoea; transthoracic echocardiogram showed moderate left ventricular dysfunction without significant progression from previous studies. Spirometry demonstrated fixed plateaued flow during forced inspiration and forced expiration. Cardiac MRI demonstrated an ejection fraction of 48% but no reversible ischaemia. Incidental note was made of an aneurysmal aberrant right subclavian artery compressing the trachea, further characterised by CT angiography (figure 1).
Arteria lusoria is an anomaly occurring in 0.5–2% of individuals, but is typically asymptomatic.1 Aneurysmal dilatation may result in tracheal compression in the absence of dysphagia.
Routine cardiac imaging techniques (transthoracic echocardiogram, coronary angiography) were insufficient to establish the correct diagnosis.
Cross-sectional imaging has a significant role to play in evaluation of patients with exertional dyspnoea whose symptoms are not explained by echocardiography.
Competing interests The authors do not have any competing interests and/or bias with regard to this publication. All authors contributed equally to this work which has not been the subject of any preceding presentation or publication.
Patient consent Obtained.
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