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Aberrant subclavian artery aneurysm?
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Aberrant subclavian artery aneurysm?

My esophagram suggests a possible aberrant subclavian artery as the possible cause of my dysphagia. I need to wait for the CT scan. I have also had the feeling that I am breathing through cloth at times. I have also been dealing with fatigue and periodic dizziness when get up from bending down.  Most concerning is that I get really sharp chest pains shooting across the right side of my chest, arm, under arm area, down right arm and sometimes into the back (thought to be from esophageal spasms).   I choked on some cereal last night and I can't seem to stop coughing since and this makes the sharp chest pain even worse. I know I should not stress about this until I know something for sure, but I am concerned that this. I am a runner and wonder if I should stop until this is figuered out. Could the chest pain be a symptom of an aneurysm?
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Avatar_f_tn
Hello, I was diagnosed with an aberrant right subclavical artery also last month when I had a ct scan done at the hospital for severe chest pain. I have a feeling that my food is stuck in my chest but don't actually choke or cough. I wish more doctors had more information about this weird abberrant artery, I think about it 24/7 and worry about an aneurysm. I too am a runner but have continued to exercise even with my severe chest pain.
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Avatar_f_tn
Hi! Thanks for commenting. This doesn't seem to be very common an I mostly come across medical article detailing surgical procedures and such. It would be great to here from someone else. In you case, I am assuming they would see the aneursym if it was present on the CT scan, right? Did they tell you what can be done about it or send you to a specialist? I know a lot of people have these and experience no syptoms (symptoms), but it it's causing pain and difficulty eating I would think they'd do something. I can only assume that if there was a sudden onset of syptoms (symptoms) then something must have changed in the structure of the artery to cause this. I'm just waiting to here from nurse today and get CT scan. Nurse said to hold off on the heavy exercise until I had that done. I too worry about this a lot and I am sure stress does not help. I mom to 3 kids (twins) and running is my only stress release at this time. Had to take a Xanax last night to get to sleep. Used to do yoga too but suddenly developed nasty reflux a few months ago too. I wondered if the reflux was also a symptom or unrelated. My chest pain does not seem to bother me while I am running (which is why they ruled out cardiac intially), but in evening after it can be really bad. It's always worse in the evenings. How about you? I can't identify any specific triggers except when I take a gulp of beer. I go a few days where it's moderate to really bad then a few days I am fine. Same with my swallowing. I been on a mostly liquid, soup and very soft food diet which I am sick of hence the failed raisin bran experiment (now I have a deep cough since). I really want to get back to running ASAP and I have the slowest doctors on earth (month between appointments, a month between tests, a month for follow up). Let me know how you are doing? Good luck!
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Avatar_f_tn
Thank you for writing back! I can't tell you glad I am to talk to someone else who is going through something similar to my situation. Here is out my diagnosis began:

Back in December, about two days before Christmas I was cooking in the kitchen and started having severe chest pain that radiated over my shoulder and down my arm. I took some pain medicine but it wouldn't go away. I went to the ER room since all the clinics were closed (it was late at night). They did a chest x-ray, EKG (to check for heart attack), but didn't find anything. They diagnosed me with "anxiety attack" and sent me home with xanax and pain meds. My chest pain continued for the next three weeks, it would come and go but still have it almost daily.

About mid January I started having upper abdominal pain, bloating, and SEVERE chest pain again. I spent two days laying in bed screaming, I felt like someone was stabbing me in the esophagus. I went back to the ER and they ran blood work, another chest x-ray but this time they said my symptoms were more related to GERD (reflux) so they gave me prilosec and advised me to follow up with a GI doctor as soon as possible (this was a saturday night). On Sunday I was in so much pain, I couldn't eat, sleep, or move and it hurt to breathe. I would just scream in pain... my family was concerned and my discharge papers at the ER said if the pain got worse to come back. I went back to the ER and this time they did a CT scan with radioactive dye (injected through IV). The ER doctor came back after the scan and said all they found was a trace (small amount) of fluid in the lining of my lungs and some reflux in my esophagus that showed up. NEVER SAID A WORD ABOUT MY ABERRANT ARTERY! He told me again to get to a GI doctor as soon as I can to have a scope done and look at my esophagus and stomach. Sent me home with pain meds which got me through until Monday.

Monday I was able to get into a Gastro doc who put me to sleep and did an endoscopy (stuck a camera all the way down to the beginning of my small intestine). He found a little bit of gastrities (inflammation) in my stomach but didn't see anything that would be causing me that much pain. He told me to continue taking the prilosec because he said it could be reflux.

The next week I followed up with my regular physician who looked at all my tests and still could not find what was causing my pain. He gave me some new medications to try that coat my stomach and esophagus to prevent damage if it is reflux. On the way out he handed me a stack of papers which he had received from the ER with all my test results (blood work, x-rays and the CT scan). When I got home, I read over the papers and read that they had "incidentally found aberrant right subclavian artery, no stenosis or dilatation (which i'm guessing would an aneurysm?) and that it was usually of no clinical significance. I started doing research and just like you... all I can find are medical journals talking about procedures! I can't believe the ER doctor, nor my primary physician said a word about it!

They still cannot find what is causing my pain. I made an appointment with a congenital cardiac surgeon on March 14th at one of the best hospitals in Utah (thats where I live) to find out if my artery is what is causing my pain and if I should be concerned. Most doctors don't really even know what it is. I don't know if thats why my physicians never said anything about it or if it is really no big deal.

From what I have read online- 60-70% of people never have symptoms from it or if they do it's either when they are infants or elderly. I'm 23 years old, a young mom of a two year old boy, and am worried sick about this artery! It's supposedly a really "rare" condition and I wish they provided more information about it. What scares me, is had I not read my papers from the hospital... I never would have known.

I still live with chest pain daily, my stomach pain seems to be getting better with the medications i'm on but I am constantly having to take pain meds (which I hate). Exercise doesn't seem to make it better or worse- and they don't think it is my heart so I still continue to exercise. I eat healthy and often feel like my food is always "stuck" in my chest or I have stabbing esophagus pain. I set up the appointment with this cardiac surgeon on my own because I think this is what is causing my pain. I know there are surgeries to fix this artery but they are dangerous and most doctors won't touch them. I am hoping this doctor in March can give me more answers!

I'm sorry you have to deal with this too- I do not have a cough like your symptoms, just pain and feeling of food being stuck. I totally understand what you mean by waiting FOREVER to see doctors... I wish it was March 14 now so I could know more. Have you had your scan yet? Sorry I wrote such a novel today- please feel free to share your story with me too :) I am just glad to talk to someone who has this same problem so I don't feel so crazy. I'm anxious all the time about it.
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Avatar_f_tn
I'm sorry you have to go through this too, but it is nice to know someone might understand. Some of your issues sound like mine but you chest pain sounds worse. I am also a mom (5yr boy, 3yr identical girls). I'm not a hypochondriac. Rarely went to the doctor until I was diagnosed hypothyroid 2 years ago. I figue I'll give you my essay and some thoughts on this.

In September, I was training for a Trail 1/2 marathon in Big Sur, so I was running a lot, big hills and feeling fine. A few days before the race I was diagnosed with Bronchitis. Total bummer. No race. Took anitbiotics. After 2 weeks or so I started back up running but just my easy 3 mile loop and had a really hard time with it but I kept trying. I was getting winded where  I shouldn't be having problems and just thought I was still getting over the Bronchitis. Around mid October, I was working in the yard (love to garden) and was getting out of breath and very tired just digging simple small holes and getting dizzy when standing. As a mom, you know how you are always bending over and standing up. I was getting winded going upstairs and finally acknowledged that I might have a problem when I was too out breath to sing my kids their bed time time songs. Laying in bed I could feel inflammation in my lungs but also sharp chest pains. Too cheap to go to the ER so waited it out over the weekend and wend to my regular doctor.

I was diagnosed with Asthma (never had it in my life nor in my family), they also is a EKG which was fine.  Doctor also thought I might have some reflux and prescibed Prilosec. In the office I was given a breathing treatment (Xopenex) which sent me into some sort of spams/ involuntary twitching & hyperventilation. That was fun with 3 little kids in the office :(. I was rolled over to the ER where they confirmed the asthma and identified the chest pain ad Coscondritis. I was sent home with asthma meds, predisone, antibiotics and a lot of ibuprofen. This cost me over $1000.

2 weeks later got strep and hand foot & mouth disease from kids. I was still having a lot of pain in my chest and wierd swallowing sensations and reflux continued to get worse. At that time, I wouldn't say that it hurt but it felt like everything was going down wierd. Like when you swallow a big pill wrong. Even my tiny thyroid pill I could feel going down. Doctor upped Prilosec to 2x day and referred my to GI.

GI thought I might have Esinophilic Esophagitis. Had endoscopy through, duodenum and upper intestines. Found a "scricture" did a ballon dialtion. All biopsies were negative and nothing else was found. I felt worse after procedure and swallowing became more painful (midchest). Cold beverages like smoothies go down and a few minutes later I can feel the cold creeping back up. GI thought I might have motility disorder, and the chest pains might be from esophageal spams. Changed PPI to Dexilant. I was referred to a specialist in San Francisco. I live on CA central coast. It took forever to get in to specialist. Had a bunch of allergy testing done. At times, I wondered if the swallowing was all in my head until we took the kids to the movies over holidays and I felt the popcorn backup in my throat and coughed really bad. The next day (18 hours later) I coughed up popcorn in the shower. Gross. So was more careful with what I ate. Right after Christmas I was eating some almonds and started to cough/ choke some from the upper area of my throat (before it was all in the mid chest area). All that day was up tiny almond bits. Same thing happened with oats the next day. UGH! Meanwhile the chest pains continued and many times I wanted to go to the ER, but kept thinking about the $.

Finally got to see GI motility specialist in January. She didn't have much to say except that she still thought it might be Esinophillic Esophagitis. I should sick to liquids and very soft foods. So 2 weeks ago I did blood work, another Endoscopy, Manometry Test, Esophageal Impedance and Esophagram. I don't have my follow up until March 14th (ironic). The waiting is killing me. In the meantime, the only info I have is that the Endoscopy showed some abnormal mucosal abnormalities. Friday I got the Esophagram results in the mail which noted a "fusiform narrowing" suggesting extrinsic impingment of the esophagus rather than intrinsic. It suggests the possibilty of an aberrant right subclavian artery and should follow up with a CT. Everything else was normal. I was kind of annoyed by this procedure as they did it so fast and didn't test me with any of the things I have trouble with like small hard bits or very cold drinks. I called the nurse and she said to ease up on the running until the CT. All my biopsies were negative for cancer, EE, Celiac, H.Pyroli. Nurse was supposed to call back yesterday but didn't. I left a message this morning but of course I have not heard a thing. I am so tired of this. I have changed to a very low acid diet. Doing a lot of bending and standing (always doing this) seems to make thing worse. My ongoing symptoms are-

Pain in the esophagus when swallowing- mid chest, some days worse than others
Sharp chest pains- Like an ice pick stabbing/ shooting from heart area across left, over and under arm, down left arm and into hand/ fingers at times. Comes and goes. Can't identify specific triggers. Pain ranges from 3-7 on 10 scale.
Fatigue- constant
Breathing issues- Feels like I am breathing through a thin cloth. No bad but not right
Low fever- often
Reflux- has been better lately
Coughing up food bits
Feeling of food stuck in esophagus- not sure if it just a feeling or if it's in there
Dizzy/ light headed feeling- at times and when standing
A bit of brain fog
Short/irrational temperment- I'm usually pretty mellow. Could be stress

The aberrant right subclavican artery seems to fit with the chest pain and some of the breathing. I am worried about it being aneurysm. It sounds like yours was not dialated which is good. I ALWAYS get copies of my tests, reports, & labs. Read them and educate myself. It's good to keep track especially when your seeing multiple doctors. This also helps me get a comprehensive list of question for my doctor so I get answers or a least progress with my appointments. I am starting a journal to try to track symptoms. I am interested to hear how you appointment goes. I sounds like you have read all the same info online that I have. I did see a hospital in Cleveland come up a lot that had done these surgeries. You are right that most of the case studies presented were elderly. You are so young. Keep persuing answers. I just urned 40 and this make me feel old. Best of luck to you!
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Avatar_f_tn
I hope your appointment went well today. I had mine today. CT showed normal subclavian artery. After many tests I still don't know what is causing my issues.
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Avatar_f_tn
I'm sorry it has taken me so long to reply... I have been sick lately (mostly with a flu/cold virus) and everyday has been a struggle to get through. I am so behind on life because of all my medical problems!

So no aberrant artery on your CT? That's good news but it's still frustrating they can't find out what is causing your pain.

My appointment on Wednesday went well- the doctor said that this aberrant artery is not really that uncommon, he sees it about once a month in patients. My echocardiograhm came back normal, he said the blood flow in that artery is great and that there is no aneurysm or narrowing of the artery. He said to remember that I have it but unless I start choking on my food or having major problems, just leave it alone. He said that the pictures they got with the echocardiograhm showed that it was not pressing on my esophagus just going behind it.

He doesn't know what is causing my chest pain either- but suggested that its chest wall inflammation (costochondrities) like you were diagnosed with... so now i'm on naproxen twice a day for ten days to see if it goes away.

I'm really frustrated at this point... I have paid a ton of money in medical bills, have multiple tests, and they can't find anything!!! Seems like that's whats going on with you too.

How are you feeling? Are you still coughing up bits of food? Did they see anything else on your CT scan that might be causing your pain?

My last attempt is now to go see a pulmonologist to find out why I have a little bit of fluid in my lungs (which showed up on the CT) and see if that is related to my pain since it is not normal to have that. The cardiologist thinks that the fluid is coming from inflammation (like costochondrities) or a collagen vasuclar disorder (like RH arthrities). So I have my next appt April 10 to see about my lungs.
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Avatar_f_tn
I totally hear you on bills they are all rolling in and I'm buried. Everything looked good on the CT scan other than evidence of reflux. Swallowing overall has gotten better but I still choke on small hard bits sometimes. I also have a problem with certain textures (soft but dense) getting stuck in upper throat near top such as rice bread, pumpkin pie filling and such. Chest pain is still really bothersome but it comes and goes.

Manometry test was pretty good exept the last few swallows which specialist seemed to blow off even though there was some sign of spasm. Ph impedence study show reflux, but not enough to "clinical". All biopsies were normal. I am now taking a low dose of Nortriptyline which is an anti-depresant that is sometimes used for chest and esophageal pain but it doesn't seem to be working at this point. I was told it could take a few weeks to get the full effect. Just had an EKG which was normal. I was referred to an ENT since they deal with the throat more and GI does the esophagus. I guess no news is good news but yes, frusterating!

I have also been experiencing a different shooting cramping like pain in my arms, hands and sometimes feet. This weekend had a few bad dizzy spells. I stopped taking Prilosec and my reflux seems a lot better. I am now trying an elimination diet to see if its has any effect on things. For that past 2 weeks, I've been off gluten, corn, wheat, dairy, alcohol, refined sugar, "mold foods" and "latex food". It's killing me. so far no change but lost a few pound since I can't snack of anything. I will start slowly adding thing back in to watch for any reaction. Since a few things were off in my blood work, I just had a bunch of Lupus tests and Rh factor done. GP said he doesn't think I have this, but needs to cover his ***. Anxiously awaiting results, patiently wait for ENT office to call, and waiting to eat real food again. I'm so tired of waiting.....
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Avatar_f_tn
My chest pain has become more like yours... it comes and goes. Somedays I am fine, others im hurled over in pain. I don't understand it. I was also put on prilosec for reflux but it seemed to make me feel like my food was stuck in my throat so I stopped... funny how a medicine that is supposed to stop reflux can make it worse.



Hope your blood work comes back okay. I have wondered about Lupus and RH Arthritis since those are collagen vascular disorders which could be an explanation for my pleural effusion (thats what the radiologist thinks) however, I don't seem to have joint pain or any symptoms of it.

I hope you can get back to a regular diet soon. When you say dizzy spells do you mean the room is spinning? Do you ever pass out?

My doctor put me on an anti-anxiety medication for chest pain also- he thinks maybe stress and anxiety are causing my symptoms since no other doctor can find anything. I guess in a way I feel blessed that nothing serious has been found, just frustrating to live in pain. Maybe I really am crazy like my doctor thinks lol. I have been to 5 different doctors in 4 months who specialize in certain areas (heart, gastro, gyno, derm, lung, etc) and they all just say they don't know. I guess as long as my pain doesn't change or seem to get worse I will just have to live with it.
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Avatar_f_tn
Hi! I hope your feeling better. I am somewhat. I have been taking a low does Nortriptyline for the past month. Chest pain have been much better the past week or so. Swallowing seems better at the moment but this still comes and goes and is worse with some food than others. The diet challange to check for food allergies came out negative.

All the lupus tests came out fine. I have some RNP antibodies, but not enough for a positive result. I still have some cramping in arms and hands but that seems a bit better at the moment as well. I have been taking CALM (magnesium) most nights. Heart burn remains better off the prilosec but I have to be care not to each too much and stay with low acid low fat foods.

I am still having dizzy spells. These happen mostly if I get up from sitting, crouching, or laying down to fast. I have not blacked out but close. I was gardening and had to jump up to help one of my kids who got hurt. As I was hurrying I started blackness and stars on my perfipheral vision and had to quickly sit down on the ground. I have had this happen a lot but this was the worst. I am trying to get up slowly now. Also at time I just feel a bit "wonky". Sort of like when your a bit buzzed or drunk and everything feels a bit off balance.

How is the medication working for you what do they have you on? A few months ago I tried Prosac but that seemed to give me anxiety symptoms. I also tried Xanax which was ok, but didn't help with the chest pain at all so I stopped.

Still waiting for the ENT to call even though I called them 2 weeks ago. Grrr... I think I can live with this unless the swallowing gets worse again. Good luck with everything.
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