Abstract
A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch.
Highlights
A right aortic arch is a relatively rare congenital anomaly, with a reported incidence of around 0.1% [1]
We report a case in which we could identify the recurrent laryngeal nerve (RLN) under video-assisted thoracic surgery (VATS)
The RLN, which branched from the vagus nerve, was recurrent around the left subclavian artery (Figure 2, A and B)
Summary
A right aortic arch is a relatively rare congenital anomaly, with a reported incidence of around 0.1% [1]. In cases of pulmonary resection for the left lung cancer with a right aortic arch, it is important to locate the vasculature and nerves, especially the recurrent laryngeal nerve (RLN), to avoid injury. It was possible to perform lobectomy with mediastinal lymph node dissection without any complications. Computed tomography showed a pulmonary tumor 2 cm in diameter in the left lower lobe and a right aortic arch (Figure 1, A and B). The patient underwent a VATS left lower lobectomy and mediastinal lymph node dissection. There was no anomaly in the location and branching of the pulmonary arteries, veins, bronchi, and the lobulation of the lungs. We identified the vagus nerve at the level of the left pulmonary artery. The RLN, which branched from the vagus nerve, was recurrent around the left subclavian artery (Figure 2, A and B). The patient was discharged without any complications such as hoarseness
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