The Presence of an Arteria Lusoria Should Be Checked When Reporting 18 F-FCH PET/CT Performed to Localize Hyperfunctioning Parathyroid Glands

ABSTRACT

Nonrecurrent inferior laryngeal nerve (NRILN) is a rare anatomical variant, which significantly increases the risk of nerve injury during neck surgery, for example, thyroidectomy or parathyroidectomy (PTX). The absence of the brachiocephalic trunk and presence of arteria lusoria (AL) are strong predictors of NRILN in the right neck. FCH PET/CT is now a recognized imaging modality in hyperparathyroidism (HPT). We report 2 patients with primary or renal HPT in whom FCH PET detected right HFPTs and low-dose noncontrast CT evidenced AL. The NRILN was thus preserved during PTX. We recommend searching for AL on FCH PET/CT (even low-dose) in HPT before PTX.

The Nonrecurrent Laryngeal Nerve Without Abnormal Subclavian Artery: Report of Two Cases and Review of the Literature

As a variant of recurrent inferior laryngeal nerve (RILN), the nonrecurrent inferior laryngeal nerve (NRILN) is closely related to the occurrence of abnormal subclavian artery (ASA). The nonrecurrent inferior laryngeal nerve has been found in patients without arterial abnormalities, which is seen in the coexistence of NRILN and RILN, but it is easily confused with sympathetic-inferior laryngeal anastomosis branch (SILAB). We encountered 2 right NRILN patients without ASA during thyroid surgery. This article summarizes the characteristics of these cases and proposes methods to distinguish the coexistence of NRILN and RILN from SILAB. So far, 11 articles have reported 16 cases of NRILN without arterial abnormalities. In patients without artery abnormality, the vagus nerve could send out a descending branch NRILN at the bifurcation of the carotid artery and enter the larynx after anastomosis with RILN. Adequate dissection of the carotid sheath may avoid confusion with SILAB, and neural monitoring is also expected to provide a reference for the identification.

Efficient, effective, safe procedure to identify nonrecurrent inferior laryngeal nerve during thyroid surgery

BACKGROUND

The nonrecurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery. CT images can detect this vascular anomaly, which predicts an NRILN. The purpose of this study was to report our procedure to identify the NRILN in patients with the aberrant subclavian artery.

METHODS

Four of 730 patients undergoing thyroid operation in our hospital were preoperatively diagnosed with aberrant subclavian artery by CT of the neck. To avoid vocal cord paralysis, we approached the vagal nerve first before dissecting the paratracheal region to discover the separation point of the NRILN from the vagal nerve.

RESULTS

The NRILN was identified without difficulty in all 4 patients. No patients showed vocal cord paralysis.

CONCLUSION

Approaching the vagal nerve first before dissecting the paratracheal region is an efficient, effective, and safe procedure to identify an NRILN in patients who are preoperatively diagnosed as having the aberrant subclavian artery.

Successful resection of esophageal carcinoma with aberrant right subclavian artery using video-assisted thoracoscopic surgery: report of two cases

The right non-recurrent inferior laryngeal nerve (NRILN) is a rare nerve anomaly that communicates the laryngeal nerve to the right vagal nerve trunk directly in the neck, which is usually accompanied by aberrant right subclavian artery (ARSA). We report on two cases of thoracic esophageal carcinoma undertaken in patients with these abnormalities: a 73-year-old woman with progressive dysphagia and a 63-year-old asymptomatic man. Although there have been 10 cases of thoracic esophageal carcinomas associated with ARSA and NRILN in literature, as far as we are aware of, this is the first report to describe successful resection using video-assisted thoracoscopic surgery (VATS). We found that the combination of preoperative recognition of the ARSA using three-dimensional computed tomography (3D-CT) and VATS in the prone position allowed for visual magnification with an excellent thoracoscopic view and facilitated successful tumor resection and preservation of NRILN.