Anomalous Pulmonary Vein in Chemo-irradiated Subcarinal Space
We present here 2 cases of Squamous cell carcinoma in mid-thoracic esophagus, who received neoadjuvant concurrent chemo-radiation as per CROSS protocol. They underwent Transthoracic radical esophageal mobilization with Mediastinal lymph node clearance successfully using VATS and Da-vinci Robotics.
Intraoperatively, we could identify an anomalous pulmonary vein draining the right lower lobe directly into the left atrium. The anomalous pulmonary vein was identified and isolated in the subcarinal space amongst the lymph nodal packet.
The authors wish to emphasize that successful identification and preservation of such an anomalous pulmonary vein is particularly important in the post chemo-irradiated subcarinal area, where the normal anatomy gets distorted due to effect of chemo-radiation induced fibrosis. Injury at this site is likely to cause torrential bleed and possible retraction of vein intrapericardially.
Lyen, S., Wijesuriya, S., Ngan-Soo, E. et al. Anomalous pulmonary venous drainage: a pictorial essay with a CT focus. J Congenit Heart Dis 1, 7 (2017).