dysphagia dysphagia
Introduction
Introduction to malformation dysphagia Dysphagiaduetovascularity (also known as arterial deformity), later dysphagia caused by congenital anomalies of the aortic arch and its main branches, commonly referred to as malformation dysphagia, also known as neck deformity Dysphagia (dysphagiaduetocervicaldeformity). basic knowledge The proportion of illness: 0.001% Susceptible people: infants and young children Mode of infection: non-infectious Complications: esophageal injury esophageal cancer
Cause
Abnormal dysphagia
Embryonic developmental malformation (30%):
The main reason is embryonic developmental malformation, vagus subclavian artery malformation, right subclavian artery directly from the aortic arch, from the distal end of the left subclavian artery opening, walking behind the esophagus to the right side to oppress the esophagus, can also walk in the trachea The esophagus is compressed between the esophagus.
Right aortic arch and left aortic ligament deformity (30%):
The aortic arch is not normal. From right to left, the descending aorta descends behind the trachea. Instead, it passes from the right to the right main bronchus and then to the descending aorta. The right aorta itself forms a vascular ring with the pulmonary artery and arterial ligament. , pressure the trachea and esophagus.
Double aortic arch deformity (15%):
The ascending aorta sends out two arterial arches, one in front of the trachea and the other in the back of the esophagus. The two recombines into the descending aorta, forming an arterial ring that encloses the esophagus and trachea, possibly accompanied by other congenital heart. disease.
The location of the innominate artery or the left common carotid artery is located at the left side of the trachea. It travels through the anterior direction of the trachea. This causes the trachea to compress the esophagus from front to back, causing tracheal stenosis and esophageal passage.
Pathogenesis
When the right subclavian artery directly starts from the aortic arch, it starts from the distal end of the left subclavian artery opening and travels to the right side of the esophagus to press the esophagus. It can also press the esophagus between the trachea and the esophagus.
The aortic arch is not normal. From right to left, the descending aorta descends behind the trachea. Instead, it passes from the right to the right main bronchus and then to the descending aorta. The right aorta itself forms a vascular ring with the pulmonary artery and arterial ligament. , pressure the trachea and esophagus.
The ascending aorta sends out two arterial arches, one in front of the trachea and the other in the back of the esophagus. The two recombines into the descending aorta, forming an arterial ring that encloses the esophagus and trachea, possibly accompanied by other congenital heart. disease.
The beginning of the innominate artery is located on the left side of the trachea, which travels through the anterior direction of the trachea. This causes the trachea to compress the esophagus from front to back, causing tracheal stenosis and obstruction of the esophagus.
Prevention
Malformation dysphagia prevention
Malformation of malformation is mainly caused by malformation of the embryo. In order to prevent fetal malformation, pregnant women need to supplement folic acid from the beginning of pregnancy. Foods rich in folic acid include red leeks, spinach, lettuce, asparagus, beans, yeast, animal liver, apples, and citrus. At the same time, regular prenatal checkups and good doctors are also positive means to avoid the birth of abnormal newborns. After the diagnosis of pregnancy, the expectant mother needs to go to the street hospital for the first antenatal checkup at 12 weeks of pregnancy, and establish a pregnant women contact health manual. Subsequent prenatal examinations can be performed in a secondary hospital or in a hospital where the birth is decided.
Complication
Malformed dysphagia Complications esophageal injury esophageal cancer
Esophageal cancer is caused by long-term esophageal injury caused by esophageal compression. Early symptoms of esophageal cancer are mild and not obvious. It is characterized by impaired obstruction of the lower pharynx, stagnation of food in a certain position, discomfort after the sternum and burning pain. Patients with lower esophageal cancer can also cause discomfort under the xiphoid or upper abdomen, hiccups, and belching. When the disease progresses to the middle and late stages, the patient has symptoms such as hoarseness, difficulty swallowing, food reflux, persistent scapular region of the back or sternum, hematemesis or melena. Although the condition will be aggravated or alleviated during the period, the overall trend is persistently aggravated. If there is anorexia or a significant weight loss, it indicates that the cancer has been widely metastasized. Patients with advanced disease may have symptoms such as dyscrasia, dehydration, jaundice, ascites, tracheal compression, dyspnea, vocal cord paralysis, coma, etc., accompanied by water and electrolyte disturbances.
Symptom
Abnormal dysphagia symptoms common symptoms dysphagia esophageal reflux symptoms neonatal laryngeal wheezing vascular sclerosis neonatal shortness
Dysphagia is the main clinical manifestation. The compression symptoms caused by right aortic arch and left aortic ligament or double aortic arch are most obvious. In the early stage after birth, there may be reflux and aspiration after feeding. The vagus inferior subclavian artery is dysphagia. Symptoms are mild, and the symptoms are obvious after adulthood due to vascular age and hardening of the arteries.
Tracheal compression symptoms: right aortic arch and left aortic ligament, bilateral aortic arch can appear tracheal compression symptoms, manifested by shortness of breath and wheezing.
Examine
Abnormal dysphagia check
1. X-ray examination: the esophageal compression of the esophageal barium meal before and after the oblique and lateral slices, the esophageal compression caused by the vagus subclavian artery is located at the rear, the tracheal compression is not obvious, the right aortic arch is seen on the X-ray film on the right side of the aortic arch. There is a deep indentation behind the esophagus in the lateral position. In the double aortic malformation, the esophagus has double impression on the anterior and posterior position and oblique position.
2. Endoscopy: in the double aortic arch, right aortic arch and left aortic ligament, endoscopic examination showed a local bulge formed by vascular compression in the posterior wall of the esophagus, the pulsation is consistent with the neck and wrist artery, and there is a right clavicle after the esophagus At the time of the inferior artery, a microscopic examination revealed a bulge that was consistent with the arterial pulsation across the posterior wall of the esophagus. When the bulge was pressed by the endoscope, the pressure was forced to a slight degree, and the right iliac artery pulsation weakened or disappeared, and the compression returned to normal after relaxation. .
3. Angiography: Anatomic deformity of the aortic arch and its main branches can be found.
4. Other imaging examinations: CT and MRI have some help in finding the anatomic deformity of the aortic arch and its main branches, and it is a non-invasive examination, and its application is more and more extensive.
Diagnosis
Diagnosis and identification of malformation dysphagia
diagnosis
There is a history of difficulty in swallowing after birth. X-ray, endoscopy, angiography, and CT and MRI imaging examinations are not difficult to diagnose. It is important to think about the disease according to the medical history and arrange the examination reasonably.
Differential diagnosis
The origin of the right subclavian artery is abnormal, and the esophagus is often pressed from the back of the esophagus. A hemispherical filling defect of 1 cm is visible on the posterior wall of the esophagus. The boundary and mucosal surface are smooth, and it is necessary to distinguish it from the submucosal tumor.
