A 68-year-old male was referred to our hospital with the suspicion of early esophageal cancer. Endoscopy-revealed a shallow erythematous depression on a mucosal elevation of 1cm in diameter at 27cm from the incisors. Histopathologic examination of biopsy specimen confirmed squamous cell carcinoma,type0-IIc. The mucosal elevation was pulsatile. Contrast-enhanced computed tomography-revealed that the elevation was the meandering left bronchial artery arising from the aorta at the Th10 level. Endoscopic submucosal dissection (ESD) was performed with sufficient submucosal injection for mucosal incision, and submucosal dissection involved countertraction to assure better visualization. Various etiologies including submucosal tumors, the aorta, varices, hemangioma, and a vertebra cause esophageal elevations. It is imperative to identify the cause of a mucosal elevation when endoscopically treating lesions on top of such elevation.
