CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(01): 117-120
DOI: 10.1055/s-0042-1758194
Case Report

An Aberrant Right Subclavian Artery–Esophageal Fistula—A Fatal Complication of a Common Anomaly: A Case Report and Review of Literature

Pavithra C. Subramanian
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Naveen Chidanandaswamy
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Raghuraman Soundararajan
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Harish Bhujade
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Nidhi Prabhakar
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations


An aberrant right subclavian artery (ARSA), also called as arteria lusoria, is one of the most common aortic arch anomalies. ARSA–esophageal fistula is a rare, life-threatening complication, with only 37 cases reported in literature. We describe a case of a young girl who developed acute episode of massive hematemesis after the recovery from novel coronavirus disease 2019 (COVID-19) pneumonia. Computed tomography (CT) angiography showed ARSA with retroesophageal course and active contrast leak in esophagus. Digital subtraction angiography confirmed the site of active contrast extravasation from the ARSA. However, the patient succumbed to hypovolemic shock even before the endovascular or surgical interventions could be done.

Authors' Contributions

Conception and design, acquisition of data, and analysis and interpretation of data: P.C.S., N.C., R.S., H.B., and N.P.

Literature search, drafting the manuscript, and revising it critically for important intellectual content: R.S., H.B., N.P., and N.C.

Manuscript editing and final approval of the versions to be published: H.B., N.P., and R.S.

Publication History

Article published online:
24 November 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Türkvatan A, Büyükbayraktar FG, Olçer T, Cumhur T. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol 2009; 10 (02) 176-184
  • 2 Merchant FJ, Nichols RL, Bombeck CT. Unusual complication of nasogastric esophageal intubation-erosion into an aberrant right subclavian artery. J Cardiovasc Surg (Torino) 1977; 18 (02) 147-150
  • 3 Oliveira E, Anastácio M, Marques A. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation. Braz J Anesthesiol 2016; 66 (03) 318-320
  • 4 Livesay JJ, Michals AA, Dainko EC. Anomalous right subclavian arterial esophageal fistula: an unusual complication of tracheostomy. Tex Heart Inst J 1982; 9 (01) 105-108
  • 5 Jungck E, Püschel K. Erosion hemorrhage from an esophago-aortic fistula in congenital anomaly of the thoracic aorta as a fatal complication of a stomach tube [in German]. Anaesthesist 1983; 32 (10) 498-500
  • 6 Belkin RI, Keller FS, Everts EC, Rösch J. Aberrant right subclavian artery–esophageal fistula: a cause of overwhelming upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol 1984; 7 (02) 87-89
  • 7 Edwards BS, Edwards WD, Connolly DC, Edwards JE. Arterial-esophageal fistulae developing in patients with anomalies of the aortic arch system. Chest 1984; 86 (05) 732-735
  • 8 Gossot D, Nussaume O, Kitzis M, Cohen G, Chalaux G, Andreassian B. Fatal hematemesis due to erosion of a retro-esophageal right subclavian artery by an esophagogastric tube [in French]. Presse Med 1985; 14 (31) 1655-1656
  • 9 Guzzetta PC, Newman KD, Ceithaml E. Successful management of aberrant subclavian artery-esophageal fistula in an infant. Ann Thorac Surg 1989; 47 (02) 308-309
  • 10 Ikeda T, Yokota Y, Ando F. et al. A case of an aberrant subclavian artery-esophageal fistula due to prolonged nasogastric intubation [in Japanese]. Kyobu Geka 1991; 44 (12) 1045-1047
  • 11 Hirakata R, Hasuo K, Yasumori K, Yoshida K, Masuda K. Arterioenteric fistulae: diagnosis and treatment by angiography. Clin Radiol 1991; 43 (05) 328-330
  • 12 Miller RG, Robie DK, Davis SL. et al. Survival after aberrant right subclavian artery-esophageal fistula: case report and literature review. J Vasc Surg 1996; 24 (02) 271-275
  • 13 Minyard AN, Smith DM. Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation. Am J Forensic Med Pathol 2000; 21 (01) 74-78
  • 14 Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM. Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries. Ann Vasc Surg 2003; 17 (03) 302-305
  • 15 Chapman JR, Sedghi S, Christie BD, Nakayama DK, Wynne JL. Aberrant right subclavian artery-esophageal fistula. Am Surg 2010; 76 (12) 1430-1432
  • 16 Jain KK, Braze AJ, Shapiro MA, Perez-Tamayo RA. Aberrant right subclavian artery-esophageal fistula and severe gastrointestinal bleeding after surgical correction of scimitar syndrome. Tex Heart Inst J 2012; 39 (04) 571-574
  • 17 Kudose S, Pineda J, Saito JM, Dehner LP. Aberrant right subclavian artery-esophageal fistula in 20-year-old with VATER association. J Pediatr Intensive Care 2017; 6 (02) 127-131
  • 18 Shires CB, Rohrer MJ. Anomalous right subclavian artery-esophageal fistulae. Case Rep Vasc Med 2018; 2018: 7541904
  • 19 Kim S, Jeon KN, Bae K. Aberrant left subclavian artery-esophageal fistula in a patient with a prolonged use of nasogastric tube: a case report and literature review. Diagnostics (Basel) 2021; 11 (02) 195
  • 20 Zhang N, Lechien JR, Martinez V, Carlier R-Y, El Hajjam M. Contribution of interventional radiologist in the management of pseudoaneurysm and neck hemorrhages in COVID-19 patients. Ear Nose Throat J 2021; 100 (2_suppl): 148S-151S
  • 21 Millar A, Rostom A, Rasuli P, Saloojee N. Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: a case report and review of the literature. Can J Gastroenterol 2007; 21 (06) 389-392