Axillary Lymph Node Metastasis in Gallbladder Carcinoma with Incidentally Detected Coexistence of Aberrant Right Subclavian Artery with Left-Sided Superior Vena Cava

Abstract

The sequential development of port site recurrence, followed by recurrence in the axillary lymph node in gallbladder carcinoma is very infrequently reported in the literature. The representing 18F-fluorodeoxyglucose positron emission tomography-computed tomography image shows a metastatic right axillary lymph node in a case of gallbladder cancer developed following surgical removal of port site recurrence and six cycles of chemotherapy. The image also shows coexistence of two incidentally detected vascular anomalies, i.e., aberrant right subclavian artery and left-sided superior vena cava. Coexistence of both the vascular anomalies is rare among the general population and have their own clinical implications as described.

Keywords: Aberrant right subclavian artery; axillary lymph node metastasis; gallbladder carcinoma; left-sided superior vena cava; port site recurrence.

Figure 1

(a) Axial positron emission tomography-computed tomography image shows metabolically active solitary enlarged metastatic right axillary node (black single arrow), well-formed aortic arch on the left side (black asterisk), origin of aberrant right subclavian artery as the last branch of aortic arch and its retroesophageal course (white single arrow). It also shows the left-sided superior vena cava anterior and to the left of the aortic arch (white double arrow). The right-sided superior vena cava is seen in its usual position (white asterisk). (b) Left superior vena cava runs adjacent to the left atrium before turning medially and draining into coronary sinus (white arrow)