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The patient is a 15 month old female with dysphasia to solid food from 6 month ago. She had  regurgitation and cyanotic attack from birth following milk feeding so with suspicious to gastro esophageal reflux underwent Omeprasol treatment ,and after beginning of solid food   such as rice and bread   she did not tolerate at all.

Ultrasound for GER was negative. Barium meal performed for her and referred to us.

PMH: She was born at term by cesarean section . Birth weight was 3200 gram    . she had no history of hospital admission  , surgery or caustic injury .

DH: negative

PHE :

BP= 110/70        PR= 110      RR=26       T=37

H&N=Ok

Chest= Ok

Abdomen :ok

Lab:

 Bs=82    BUN= 10   Cr= 0.6   Na=138   k+ 4.6  Ca=9.8    PT=1.1  INR=1.1  PTT=30

Hb=12.2  HCT=34  PLT=384000

WBC=77000   Neut =10%   Lymph=88%  Eosino=2%  Atypl.Lymph=8%

Her physician in another center requested Barium meal.

We performed esophagoscopy for her that there were no intraluminal lesion but was suspected to extraluminal pressure.

So we requested CT angiography.

What is your diagnosis?  What is the best treatment?

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