2012 Volume 26 Issue 7 Pages 757-761
A 76-year-old male sought medical attention after complaining of pain in the right shoulder. Further examination revealed squamous cell lung carcinoma in the right upper lobe associated with the right aortic arch, corresponding to type I as classified by Stewart and Edwards. In terms of pathology, the tumor was identified as T3N0M0 (p-stage IIB), having invaded the chest wall directly and being devoid of detectable metastases in lymph nodes or distant organs. There was no indication of cardiac anomalies in the present case, and we performed a right upper lobectomy with combined chest wall resection and lymph node dissection. The right recurrent laryngeal nerve had branched upward from the right vagal nerve, encircling the right aortic arch, and great care was taken to conserve the nerve during mediastinal lymph node dissection. No postoperative complications such as hoarseness were present. The case above demonstrates the need for careful attention to the recurrent laryngeal nerve pathway and associated malformations during preoperative evaluation to avoid perioperative complications that accompany surgery for lung carcinoma associated with the right aortic arch. Further research into the range of lymph node dissection based on the lymph flow, through an examination of additional cases associated with the right aortic arch, will likely be necessary.
