Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work.Malingering is not a medical diagnosis, but may be recorded as a "focus of clinical attention" or a "reason for contact with health services". Malingering is categorized as distinct from other forms of excessive illness behavior such as somatization disorder and factitious disorder, although not all mental health professionals agree with this formulation.Failure to detect actual cases of malingering imposes an economic burden on health care systems, workers compensation programs, and disability programs, such as Social Security Disability Insurance and veterans disability benefits. False accusations of malingering often harm genuine patients or claimants. History
Antiquity
According to 1 Samuel in the Old Testament, King David feigned madness to Achish, the king of the Philistines. Some scholars believe this was not feigned but real epilepsy, and phrasing in the Septuagint supports that position.Odysseus was said to have feigned insanity to avoid participating in the Trojan War.Malingering was recorded in Roman times by the physician Galen, who reported two cases: one patient simulated colic to avoid a public meeting, and another feigned an injured knee to avoid accompanying his master on a long journey. Renaissance
In 1595, a treatise on feigned diseases was published in Milan by Giambattista Silvatico.
Dysphagia lusoria (or Bayford-Autenrieth dysphagia) is an abnormal condition characterized by difficulty in swallowing caused by an aberrant right subclavian artery. It was discovered by David Bayford in 1761 and first reported in a paper by the same in 1787. Pathophysiology
During development of aortic arch, if the proximal portion of the right fourth arch disappears instead of distal portion, the right subclavian artery will arise as the last branch of aortic arch. It then courses behind the esophagus (or rarely in front of esophagus, or even in front of trachea) to supply blood to right arm. This causes pressure on esophagus and results in dysphagia. It can sometimes result in upper gastrointestinal tract bleeding. Investigation of choice - CT angiography

Treatment
Surgical repair is performed. Reconstruction or ligation of aberrant right subclavian artery by sternotomy/by neck approach. Eponym
David Bayford called it dysphagia lusoria because in Latin, lusus naturæ means sports of nature or natural anomaly. Bayford-Autenrieth dysphagia is eponym for Bayford and Autenrieth. See also
Aberrant subclavian artery
Ortners syndrome

References


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