Dysphagia megalatriensis

Dysphagia megalatriensis, also known as cardiovascular dysphagia or cardiac dysphagia, is an impairment of swallowing due to esophageal compression from a dilated left atrium.

Clinical presentation

Presentation is generally with mild dysphagia, although a minority of patients will have dysphagia severe enough to develop weight loss and nutritional imbalances . The most serious complication is development of an atrio-esophageal fistula resulting in fatal hematemesis .

Dysphagia may or may not be present with other symptoms and syndromes of left atrial enlargement such as hemoptysis or Ortner syndrome .

Pathology

Esophageal compression and resultant dysphagia secondary to left atrial enlargement is considered to be very uncommon . This is likely because when the left atrium enlarges posteriorly, the esophagus is usually able to 'slip' to either side of the vertebral bodies and thus, avoid being compressed until the left atrium is very large .

Similar syndromes are seen secondary to other vascular anomalies, such as an aberrant right subclavian artery (dysphagia lusoria) or an aneurysmal or tortuous aorta (dysphagia aortica) .

Radiographic features

Due to the rarity of this condition, it is important to exclude other commoner causes of dysphagia before settling on this diagnosis .

Plain radiograph

Chest radiographs demonstrate features consistent with left atrial enlargement .

Fluoroscopy

Barium swallow or esophagography of the esophagus reveals delayed transit and demonstrates an indentation in the esophageal wall by the dilated left atrium .

CT/MRI

These cross-sectional modalities will allow the best visualization of a dilated left atrium compressing the esophagus .

Treatment and prognosis

Treatment is necessary only if symptomatic, and generally patients will require a nasogastic tube for enteric feeding . Management of the underlying cause of left atrial enlargement (e.g. mitral stenosis or chronic mitral regurgitation) is also pertinent.