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BACKGROUND/AIM Right aortic arch (RAA) is a rare abnormality of the aortic arch that forms a vascular ring. Oesophageal cancer (EC) accompanied with RAA is even rarer, and in such cases, it is very important to understand the anatomical structure in the upper mediastinum in order to perform a safe and curative operation. PATIENTS AND METHODS A 67-year-old man who presented with pharyngeal discomfort was admitted to our hospital. Further examinations revealed advanced thoracic EC accompanied with RAA and aortic diverticulum. RESULTS After neoadjuvant chemotherapy, we successfully and safely performed thoracoscopic oesophagectomy and lymphadenectomy using the prone positioning. CONCLUSION There exist only a few reports of thoracoscopic oesophagectomy for EC with RAA. Sufficient preoperative preparation and sharing an adequate strategy for the surgical approach with the surgical team are definitely necessary. Although the thoracoscopic approach for EC with RAA is useful, more considerations are needed for some issues.

Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiology of hoarseness and is extremely rare. Because of this rarity, the practicing otolaryngologist may miss this finding while evaluating a case of idiopathic right vocal cord paralysis. Thus, the authors feel that idiopathic or unexplained right vocal cord paralysis should be routinely investigated with a CT or MRI of neck and chest with or without contrast to avoid such shortcomings. There is only one such case of right vocal cord paralysis by right aortic which has been reported earlier in literature.

Anomalies of the aortic root vessels may present in adulthood and are not uncommonly found. We present a case of a middle-aged man who was found to have a Kommerell's divericulum during standard vascular imaging. Vascular ring presenting for the first time in adulthood may run a benign course requiring no surgical intervention or repair.

1. Cina CS, Althani H, Pasenau J, Abouzahr L. Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg. 2004;39:131-9. 2. Kapustin AJ, Litt HI. Diagnostic imaging for aortic dissection. Semin Thorac Cardiovasc Surg. 2005;17:214-23. 3. Flachskampf FA. Assessment of aortic dissection and hematoma. Semin Cardiothorac Vasc Anesth. 2006;10:83-8. 4. Eltzschig HK, Rosenberger P, Lekowski RW Jr, Scott JD, Locke A, Shekar PS, et al. Role of transesophageal echocardiography in patients with suspected aortic dissection. J Am Soc Echocardiogr. 2005;18: 1221. 5. Ko SF, Ng SH, Fu M, Lo PH, Cheng YF, Lee TY. Dissection of retroesophageal aortic diverticulum and descending aorta in a patient with right aortic arch: magnetic resonance demonstration. Cardiovasc Intervent Radiol. 1996;19:438-41.

A 32-year-old woman was referred for evaluation of a 3-year history of exertion dyspnea. An anomalous vascular ring created by a right aortic arch with mirror-image branching, left descending aorta, and aortic diverticulum narrowed the trachea circumferentially. This feature was surgically approached through a right posterolateral thoracotomy, and simple amputation of the aortic diverticulum resulted in immediate symptomatic relief.

The anatomy of the aberrant left subclavian artery in a right-sided aortic arch is different in patients with tetralogy of Fallot than in persons with a normal heart. In all eight patients with tetralogy of Fallot and aberrant left subclavian artery in this series, the left subclavian artery arose directly from the distal aortic arch. In contrast, normal persons with right aortic arch and aberrant left subclavian artery invariably have an aortic diverticulum from which the left subclavian artery and the left ductus arteriosus originate. The possible different embryologic events responsible for these two forms of aberrant left subclavian artery are discussed.

The aortic diverticulum, a large bulge on the lesser curvature of the aortic isthums, is an occasional variation found during thoracic aortography in patients with a left aortic arch and normal origin of the brachiocephalic arteries. Although it is commonly thought to be a remnant of the closed ductus arteriosus, the results of this study support the hypothesis that it is a remnant of the right dorsal aortic root.

RIGHT-SIDEDRETRO-ESOPHAGEALAORTA(PERSISTENCE OF THERIGHTAORTICARCH):ANEWCLINICAL ANDROENTGENPICTURE.DR.AARONARKIN(by invitation). A new form of aortic anomaly was presented. It consists of a total persistence of the right aortic arch, together with a persistence of the left aortic arch in the form of the left subclavian artery, a short obliterated vessel and a diverticulum of the aorta; in other words, a persistence of both aortic arches. The right arch forms the aorta. The left arch forms the beginning portion of the left subclavian artery, the obliterated vessel (isthmus stenosis) and the aortic diverticulum (left descending dorsal aortic root). The patient, a man, aged 50, was examined by Dr. Arkin at the Wenckebach Clinic, Vienna. He presented the following roentgen appearance: 1. There was a shadow to the right of the sternum, running upward to the region of the head of the

This is the first clinical and angiographic description of congenital subclavian steal in a patient with left aortic arch, isolation of the right subclavian artery, and an aortic diverticulum.

Summary The authors record a case of congenital hemihypertrophy in a woman of 24 years. Diagnosis is usually made earlier in infancy or childhood. The principal features of this curious malformation are described. Associated malformations are common. In the present case, a particular malformation is stressed, namely an abnormality of the aortic arch with a right-sided aorta and low implantation of the left subclavian artery which arose from an aortic diverticulum. Another interesting point is the presence of anomalies of the extremities, brachydactyly, and syndactyly. Cutaneous and ocular anomalies are more common and the condition appears to be related to phacomatosis. The different theories of the pathogenesis of the condition are discussed.

DIVERTICULA of the aortic arch are rare congenital anomalies found as a component of vascular rings in infants. They may occur with either a right or a left aortic arch and represent persistence of the contralateral dorsal aortic root1 (Fig. 1). There are several reports concerning their diagnosis in adults by means of routine roentgenographic studies of the chest.1 2 3 4 5 6 However, angiographic studies of such patients have rarely been reported. The purpose of this paper is to describe 4 patients, each referred for the evaluation of a mediastinal mass, in whom angiography demonstrated the presence of an aortic diverticulum. One of . . .