Aberrant right subclavian artery (ARSA) presenting with esophageal pseudo-neoplastic symptoms, dyspepsia, and hemodynamic findings.

Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. Though often asymptomatic, it may cause esophageal compression and mimic neoplastic lesions. Accurate diagnosis via CT angiography is essential, especially before thoracic or cervical surgery. A 68-year-old woman presented with dyspepsia, dyspnea, and epigastric pain. Endoscopy revealed a polypoid lesion suggestive of malignancy. CT imaging showed ARSA passing posterior to the esophagus, with no mass detected. Hemodynamic evaluation revealed inter-arm blood pressure discrepancy and bradycardia. ARSA can lead to dysphagia lusoria and other compressive symptoms. Its association with Kommerell's diverticulum and non-recurrent laryngeal nerve has surgical implications. Treatment options include open, endovascular, and hybrid approaches. ARSA should be considered in patients with atypical esophageal symptoms. Imaging plays a key role in diagnosis and guiding appropriate, individualized treatment.