Arterio-Esophageal Fistula: A Rare but Fatal Complication of Aberrant Right Subclavian Artery

Aberrant right subclavian artery (ARSA), or arteria lusoria, is a relatively common congenital vascular anomaly. In about 60% of cases, it originates from Kommerell's diverticulum, an aneurysmal remnant of the right distal aortic arch. Most patients are asymptomatic; however, aneurysmal ARSA in rare instances can cause fatal complications by forming a fistulous connection between the aberrant artery and the esophagus. Here we report a case of ARSA in an 84-year-old man who presented with massive hematemesis after long-term rigid nasogastric tube intubation and expired despite intensive resuscitation. Learning from this case, we share recommendations for successfully diagnosing and managing similar situations.