[A surgical case of vascular ring (Edwards IIIB) with dysphagia evaluated by esophageal scintigraphy]

Severe esophageal compression due to a vascular ring rarely develops after childhood. We report a case of a 35-year-old man with dysphagia associated with a vascular ring. Radionuclide transit studies were performed before and after surgery for quantitative evaluation of deglutition. Preoperative aortogram disclosed a right sided aortic arch and a retroesophageal left subclavian artery arising from a diverticulum of the arch. Because of the severity of his symptoms, he was taken to surgery. He underwent posterolateral thoracotomy through the fourth intercostal space and division of the ligamentum arteriosum. The esophagus was mobilized from the aortic arch, the arch diverticulum, the pulmonary artery, and the trachea. Postoperatively, he experienced immediate resolution of dysphagia and quickly began eating a regular diet. Although a postoperative esophagogram revealed the esophageal compression, esophageal scintigraphy using 185 MBq 99mTc pertechnetate revealed shortening of the transit time of swallowed water by 1.0 second after surgery. Quantitative evaluation of deglutition in the esophagus by scintigraphy was useful for this patient, since he suffered from psychiatric problems.