A Case of Resected Esophageal Cancer with Right Aortic Arch

Abstract

We report a case of esophageal cancer with a right aortic arch. A 65-year-old man admitted to the hospital for dysphagia was found in endoscopic examination to have Type 3 esophageal cancer in the middle thoracic esophagus, and the tumor was shown histopathologically to be moderately differentiated squamous cell carcinoma. Chest X ray taken on admission showed that he had a right aortic arch and an upper GI series showed a compression defect by a vascular ring in the upper thoratic esophagus and irregular stenosis in the middle esophagus. CT showed esophageal wall thickening but no lymph node metastasis. Three-dimensional computed tomography (3D-CT) showed the right aortic arch with an aberrant left subclavian artery and ductus arteriosus (DA) originating from a diverticulum at the descending aorta (Edwards's type IIIB1). Left thoracotomy was used for this anatomical variation to approach the DA and the esophagus. After division of the DA, we conducted subtotal esophagectomy and intrathoracic esophagogastrostomy because of severe scar after a previous cervical trauma. We saw that the tumor had invaded the left bronchus and could not conduct curative operation. In the treatment of esophageal cancer with a right aortic arch, preoperative 3D-CT is very useful in determining the anatomical relationships among vessels, esophagus, and possible location of recurrent laryngeal nerves.