PMC7550825_01
Upper gastrointestinal endoscopy imaging.. The upper gastrointestinal endoscopic examination shows a protruding tumor in the lower thoracic esophagus.
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Esophagogastroduodenoscopy (Fig. 1) showed a type 1 tumor in the lower thoracic esophagus, and pathological analysis of the tumor biopsy demonstrated SCC.
Barium esophagography scan.. The scan reveals a space-occupying lesion in the lower thoracic esophagus (arrows).
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Barium esophagography (Fig. 2) showed a bulging lesion, 6-cm long, in the lower esophagus with mild dilatation of the upper esophagus.
Contrast-enhanced computed tomography (CT) scans.. The scan shows a 6-cm-long mass lesion with contrast enhancement in the lower thoracic esophagus (arrow).
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Contrast-enhanced multidetector-row computed tomography (MDCT) scans showed a space-occupying lesion with contrast enhancement, measuring 6 x 3 cm, in the lower thoracic esophagus (Fig. 3).
(a) Preoperative reconstructed three-dimensional computed tomography (3D-CT) imaging. The image shows an aberrant V2 (arrowhead) passing behind the right intermediate bronchus and merging with RSPV (arrow). LA: left atrium, RSPV: right superior pulmonary vein, RB: right bronchus.. (b) Preoperative reconstructed three-dimensional computed tomography (3D-CT) imaging. The image reveals the aberrant V2 (arrowhead) and branches of the right bronchial artery (thin arrow) running through the subcarinal nodal packet (thick arrow). BA: right bronchial artery, LA: left atrium.
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Moreover, 3D-CT images clearly depicted an aberrant V2 passing behind the right intermediate bronchus (Fig. 4a), penetrating the subcarinal nodal packet (Fig. 4b), and merging with RSPV (Fig. 4a).
(a) Subcarinal lymph node dissection. View of the subcarinal lymph node dissection showing the aberrant V2 (arrowhead) embedded in the subcarinal nodal packet (arrow). RB: right intermediate bronchus.. (b) Subcarinal lymph node dissection. View of the subcarinal lymph node dissection showing the completion of subcarinal lymphadenectomy without injury to the aberrant V2 (arrow). LA: left atrium, RB: right intermediate bronchus.
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As depicted on the preoperative 3D-CT images, a relatively large aberrant V2 involving the subcarinal nodal packet was recognized behind the right intermediate bronchus (Fig. 5a). After reaching near the root of RSPV, the nodal dissection on the pericardium was advanced cranially, and subcarinal lymphadenectomy was completed without injury to this anomalous vein (Fig. 5b).