PMC6877992_01
(a) Eosinophilic esophagitis with eosinophilic microabscess showing aggregates of mainly intact eosinophils in an area of mucosa associated with epithelial cell degeneration (H&E, magnification x200). (b) Eosinophilic esophagitis showing numerous intraepithelial eosinophils (measuring >40 per high-power field) and accumulation of eosinophils in the superficial portion of the epithelium (H&E, magnification x200).
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He had an increased eosinophilic count of >15/hpf (Figure 1) in both biopsies and was diagnosed with eosinophilic esophagitis.
(a) Eosinophilic esophagitis showing accumulation of eosinophils within the superficial necroinflammatory debris. The intraepithelial eosinophils measure >30 per high-power field. There is marked reactive squamous hyperplasia (H&E, magnification x200). (b) Eosinophilic esophagitis with eosinophilic microabscess and increased intraepithelial eosinophils measuring >30 per high-power field (H&E, magnification x400).
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He continued to have elevated eosinophils on repeat endoscopy despite steroid and elimination diet though the eosinophilic count was significantly decreased compared to previous esophageal biopsy (Figure 2).
(a) Cross section of the chest with the right-sided aortic arch (yellow) with the subclavian artery (blue) enclosing the esophagus (green). (b) Coronal section of the chest and neck with esophageal compression due to the subclavian artery (yellow) and debris retention (blue). (c) Sagittal section of the chest and neck with esophageal compression due to the subclavian artery (yellow) and debris retention (blue).
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To further delineate the cause of recurrent esophageal impaction, computed tomography (CT) scan of the neck and chest was performed which revealed an aberrant left subclavian artery arising from the right-sided aortic arch compressing the upper esophagus (Figures 3(a)-3(c)).
Esophagram with the upper esophageal compression.
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Barium esophagogram reviewed compression in the upper esophagus (Figure 4).
Type N1 morphology of the aberrant right subclavian artery (blue) arising from right side aortic arch (yellow) shown in 3D reconstruction of the computerized tomography-assisted angiography of the neck and chest.
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The three-dimensional reconstruction of the CT angiographic revealed type N-1 morphology of the aberrant right subclavian artery (Figure 5).