A Case Report of Lower Thoracic Esophageal Adenocarcinoma Associated with Right Aortic Arch

Kazuo Koyanagi, Hiroto Fujisaki, Toshio Kanai, Motohito Nakagawa, Keigo Matsumoto, Takeshi Nagase, Kouji Okabayashi, Makoto Takeda, Takahiko Misumi* and Takayuki Shiomi**

Department of Surgery, Department of Cardiovascular Surgery* and Division of Histopathological Diagnosis**, Hiratsuka City Hospital

Esophagectomy through right thoracotomy is usually conducted for thoracic esophageal carcinoma. We report a case of thoracic esophageal adenocarcinoma associated with a right-sided aortic arch. A 67-year-old man admitted for dysphagia was found in preoperative examination to have esophageal cancer in the lower third of esophagus, and the tumor was shown histopathologically to be well-differentiated adenocarcinoma. Three-dimensional computed tomography (3D-CT) showed a right aortic arch with an aberrant left subclavian artery and ductus arteriosus (DA) originating from a diverticulum at the descending aorta (Edward's type IIIB). Left thoracotomy was used for this anatomical variation to approach the thoracic esophagus and DA. After division of the DA, we conducted subtotal esophagectomy and intrathoracic esophagogastrostomy. Histopathological examination showed that cancerous tissue derived from the glands of the esophagus, not the stomach. Preoperative evaluation of vascular anatomy using 3D-CT is thus recommended for safe surgery of esophageal carcinoma associated with a right-sided aortic arch.

Key words
esophageal adenocarcinoma, right-side aortic arch, 3D-CT

Reprint requests
Kazuo Koyanagi Department of Surgery, Hiratsuka City Hospital
1-19-1 Minamihara, Hiratsuka, 254-0065 JAPAN

Accepted
March 26, 2008

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