Dysphagia, Regurgitation 2 (Differential Diagnosis)

This esophagography was performed in a 3-month-old girl because of chronic vomiting and suspected chronic dysphagia and regurgitation. The proximal esophagus has a twisted course and is slightly dilated. It is difficult to differentiate between dysphagia, regurgitation and vomiting at the age of 3 months. The history of additional choking and hypersalivation is useful information for the differentiation between the two signs. The x-ray suggests a vascular ring anomaly compressing the esophagus from the outside against the trachea and leading to its deviation; such a vascular ring anomaly was in fact present. The most important type of vascular ring anomaly is a double aortic arch. It leads to the described symptoms; a lateral view of the esophagography shows more distinctly the actually visible deviation; it is called the 'offset of the longitudinal axis'.