Tracheobronchial anomaly: One-lung ventilation difficulty during thoracoscopic esophagectomy for esophageal cancer

We describe a case of difficult deflation of the upper right lobe caused by the existence of a tracheobronchial anomaly during the thoracoscopic esophagectomy. A 70-year-old man with a history of myocardial infarction and dysphagia was diagnosed with thoracic esophageal squamous cell carcinoma. Endoscopy revealed a type 2 tumor in the lower esophagus and a superficial lesion in the middle esophagus and computed tomography showed no evidence of metastasis. We performed 2 courses of neo-adjuvant chemotherapy followed by thoracoscopic esophagectomy. During surgery, one-lung ventilation using right bronchus balloon occlusion was performed. However, the upper lobe of the right lung did not deflate, and upper mediastinal dissection was difficult. Intraoperative bronchoscopy revealed a right tracheal bronchus arising from just under the bifurcation. We reviewed the preoperative 3-dimensional computed tomography, which showed the right tracheal bronchus causing intraoperative incomplete deflation of the upper lobe. We recommend investigating this anomaly with 3-dimensional computed tomography before thoracoscopic esophagectomy.