Broncho-pulmonary abnormalities

Thoracoscopic right upper lobectomy in a patient with displaced posterior segmental bronchus and vascular abnormalities: a case report

BACKGROUND

Displaced posterior segmental bronchus (B2) accompanied by anomalous pulmonary vessels is a very rare condition. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer, especially thoracoscopic surgery.

METHODS

We reported a case of thoracoscopic right upper lobectomy in a patient with a displaced B2 and pulmonary vascular variation.

RESULTS

A 74-year-old woman was admitted to our hospital with a 2.2 cm × 2.1 cm nodule in the right lung. Three-dimensional computed tomography (3D-CT) revealed the combined apical/anterior segmental branch (B1 + 3) taken off the beginning of the right main bronchus (RMB), at the level of the carina. The displaced B2 taken off the end of the RMB. The anomalous central vein (CV), which passed between B2 and B1 + 3, ran dorsal to the main pulmonary artery (MPA) and directly into the left atrium. The patient consequently underwent uniportal thoracoscopic right upper lobectomy and mediastinal lymph node dissection. The intraoperative findings were completely consistent with 3D-CT.

CONCLUSIONS

This paper reports a case of a displaced B2 combined with right upper pulmonary vessels malformation. Under the guidance of 3D-CT, the right upper lobectomy was successfully completed by single hole thoracoscopic surgery.

Tracheal bronchus: a rare cause of recurrent pneumonia in adults

Tracheal bronchus, also known as bronchus suis, is a rare congenital anomaly of the airway where an accessory bronchus originates directly from the trachea. With an estimated incidence of 0.001%-2.0%, this condition is rarely reported in literature. It is usually discovered as an incidental finding in an otherwise asymptomatic individual. However, it can act as a focus of recurrent infection or present as persistent radiographic infiltrates. Multidetector CT imaging and bronchoscopy play a crucial role in the identification of this entity. We hereby report the case of a middle-aged man who presented with recurrent right upper lobe pneumonia, which was found to be due to an underlying tracheal bronchus.

Lobectomy for lung cancer with a displaced left B1 + 2 and an anomalous pulmonary vein: a case report

Background

A displaced left B^1 + 2 accompanied by an anomalous pulmonary vein is a rare condition involving complex structures. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer.

Case presentation

A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B^1 + 2 and hyperlobulation between S^1 + 2 and S³, while the interlobar fissure between S^1 + 2 and S⁶ was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V^1 + 2 joining the left inferior pulmonary vein and a branch of the V^1 + 2 running between S^1 + 2 and S⁶. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V^1 + 2 and confirm the locations of B^1 + 2 and B⁶ when dividing the fissure.

Conclusion

The aim of the surgical procedure performed in this case was to divide the fissure between S^1 + 2 and the inferior lobe to reduce the risk of an unexpected bronchial injury. 3D-CT helps surgeons to understand the stereoscopic positional relationships among anatomical structures.

Left superior segmentectomy for a patient with displaced anomalous apicoposterior branches of the pulmonary vein and bronchus: a case report

Background

Knowledge of anatomical abnormalities and variations in pulmonary vessels and bronchi is critical for patients requiring a lung segmentectomy. To the best of our knowledge, this is the first case of a tumor existing in the lower lobe in conjunction with a displaced B¹⁺² in which the B¹⁺² was not accidentally cut during surgery.

Case presentation

A 71-year-old woman was referred to our hospital after a part-solid lung cancer was found in the superior segment of her left lung on chest computed tomography. Preoperative three-dimensional computed tomography revealed a displaced anomalous left B¹⁺² arising from the left main bronchus and anomalous V¹⁺² returning to the inferior pulmonary vein. We identified these anomalies during surgery and performed a left superior segmentectomy. After an unremarkable recovery, the patient was discharged from the hospital on the eighth day postoperative.

Conclusions

We used a three-dimensional construction system during the preoperative planning of the pulmonary segmentectomy to better understand the bronchovascular structures. When performing surgery where anatomical abnormalities are present, there is the possibility of misidentification. Using the three-dimensional construction system, it was possible to perform safer surgery, as the surgeons were able to preoperatively prepare for any abnormalities.

Video-assisted thoracoscopic right upper lobectomy in a patient with a displaced bronchus and vascular abnormalities

Bronchial abnormalities are rare, and they are infrequently associated with pulmonary vascular abnormalities. It is important to identify such abnormal anatomical structures before lobectomy of the lung under thoracoscopy. There have been only three reports on video-assisted thoracoscopic lobectomy in patients with anomalous bronchi and vascular abnormalities to date. Here, we present a report of video-assisted thoracoscopic right upper lobectomy performed in a patient with bronchial and vascular abnormalities. Both preoperative imaging and intraoperative findings revealed a displaced anomalous B² bronchus arising from the bronchus intermedius, as well as abnormal distribution of the aberrant vein V² draining into vein V⁶ . It is critical to understand the precise anatomical structures preoperatively to perform video-assisted thoracoscopic pulmonary lobectomy safely.

A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report

Background

Since a displaced bronchus related to the left upper lobe is an uncommon anatomical anomaly, it has a risk of being accidentally resected during left upper lobe resection unless they are identified preoperatively. A case of video-assisted thoracic surgery (VATS) segmentectomy that was safely performed under preoperative identification of a displaced subsegmental bronchus and anomalous pulmonary vessels is presented.

Case presentation

A 48-year-old woman visited our hospital because of an abnormal shadow on a radiograph on a health check. The chest computed tomography (CT) showed a multicystic mass with a diameter of 35 mm on dorsal interlobar parenchyma between the S¹⁺² and S⁶ segments in the left lung. The three-dimensional (3D) CT with multiplanar reconstruction showed that B¹⁺²b+c passed to the dorsal side of the left main pulmonary artery (PA), which was considered a displaced bronchus. The branch of A⁶ arose from the left main PA at the level of the branches of A³ and A¹⁺², more proximal than the normal anatomy, and passed to the dorsal side of a displaced B¹⁺²b+c. The branch of V¹⁺² passed between B⁶ and the bronchus to the basal segment and joined V⁶ at the dorsal side of the pulmonary hilum. Intraoperative findings of the anatomy of the bronchi and pulmonary vessels were exactly the same as the preoperative 3D CT findings, so segmentectomy of S¹⁺²b+c and S⁶ by VATS was performed safely. Then there were accessory fissures between S¹⁺² and S³ and between S⁶ and the basal segment. The pathological diagnosis was a left lung abscess.

Conclusions

A preoperative 3D CT may be helpful for identifying anatomical anomalies. An anatomical anomaly should be suspected if accessory fissure is found during surgery.

Left upper division segmentectomy with a simultaneous displaced bronchus and pulmonary arteriovenous anomalies: a case report

Background

A displaced bronchus is a rare disorder of the left upper lobe. Displaced bronchi are often accompanied by an anomaly of a pulmonary artery, but rarely of a pulmonary vein.

Case presentation

We here present a patient with primary lung cancer and simultaneous migration abnormalities of the pulmonary artery and vein in a displaced bronchus of the left upper lobe. Previous reports and our findings indicate that anomalies of the pulmonary artery and vein combined with a displaced bronchus of the left upper lobe have the following characteristics: (1) the left main pulmonary artery does not cross the dorsal side of the displaced bronchus; (2) V^1 + 2 returns to the inferior pulmonary vein; and (3) there is an accessory fissure (aberrant fissure) in the segments dominated by the displaced bronchus.

Conclusions

Prevention of intraoperative damage during procedures for a displaced bronchus and pulmonary arteriovenous anomalies requires careful preoperative evaluation and surgical technique with particular attention to the above-listed characteristics.

[One-lung ventilation in a patient with a tracheal bronchus]

We report a patient in whom a tracheal bronchus was discovered intraoperatively during an endoscopy control. This observation led us to a focus on what to do in such cases.

Video-assisted thoracic surgery lobectomy for lung cancer with displaced b(1+2.)

A 52-year-old man was diagnosed with lung adenocarcinoma in the left upper lobe (c-T1bN0M0). Preoperative bronchoscopy revealed a displaced anomalous B(1+2) arising from the left main bronchus. Multiplanar reconstruction computed tomography showed that the displaced B(1+2) was located behind the left main pulmonary artery, and the interlobar fissure was largely fused. Video-assisted thoracic surgery (VATS) left upper lobectomy was performed successfully. The "no-touch fissure" technique was efficient not only for avoiding accidental cutting of the displaced bronchus but also post-operative air leakage. This is the first reported case of VATS lobectomy for lung cancer associated with a displaced B(1+2).

Congenital abnormalities of intrathoracic airways

Multidetector CT has broadened the potential of imaging to demonstrate anomalies of the lung and the tracheobronchial tree with increasing frequency. Two-and three-dimensional reformatting improve the understanding of complex tracheobronchial anomalies. Most congenital tracheobronchial anomalies are rare and almost always nonsymptomatic; however, some may be confused with or even responsible for respiratory disease. Tracheal and accessory cardiac bronchi are among the most frequent anomalies, but other ectopic or supernumerary lung buds, developmental tracheobronchial interruption, obstruction, or compression, communicating bronchopulmonary foregut malformations, and bronchial malformations associated with anomalies of situs can be detected, even late after birth.

Preoperative evaluation of a tracheal bronchus by three-dimensional 64-row multidetector-row computed tomography (MDCT) bronchography and angiography: report of a case

We performed successful surgery for lung cancer after confirming the anatomical abnormality of a tracheal bronchus by three-dimensional multidetector-row computed tomography (3D-MDCT) bronchography and angiography. Tracheal bronchus is unusual, and right upper lobectomy for lung cancer would rarely be performed in a patient with a tracheal bronchus. Most clinicians are unfamiliar with the anatomy of a right upper lobe that includes a tracheal bronchus. Preoperative 3D imaging of the tracheal bronchus and its related vessels familiarized us with the anatomy of this patient before the operation. Thus, we recommend preoperative 3DMDCT bronchography and angiography, especially for patients with a possible bronchial anomaly.

A human case of an azygos lobe: determining an anatomical basis for its therapeutic postural drainage

An azygos lobe of the human lung is one of the most common lung malformations. However, there are only a few anatomical reports concerning the bronchial and blood supply to this lobe. We encountered the azygos lobe in an anatomical dissection course. The azygos lobe of this case was examined macroscopically and lung parenchyma, including alveoli, terminal bronchioles, and bronchial arteries and veins, was partially removed under a stereoscopic microscope. The azygos lobe was situated medial to the superior lobe and superior to the hilum of the right lung. The parietal pleura wrapped around the azygos vein like a mesentery to form the "meso-azygos." Partial removal of the lung parenchyma revealed that the azygos lobe received bronchial branches from the medial components of the apical and anterior branches of the apical segmental bronchus (B(1)a and B(1)b), and that these bronchial branches were bent excessively in a medial direction from the parent bronchial trunk. For therapeutic drainage of secretions from a right azygos lobe, a 45 degrees upright sitting posture with the neck flexed to the right side is recommended, because in this posture the bronchial branches to the azygos lobe assume a more vertical orientation to facilitate greater dependent drainage of this lobe.

HRCT evaluation of the accessory fissures of the lung

INTRODUCTION

The purpose of this study was to classify the accessory fissures of the lung and to assess their frequency by using high-resolution CT.

METHODS AND PATIENTS

HRCT scans of 115 patients were prospectively reviewed. 1 mm thin sections were obtained at 10 mm intervals with a scan time of 1.9 s. The fissure and its relationship to the segmental bronchovascular structures were then evaluated on transverse sections.

RESULTS

Forty-four accessory fissures were detected in 35 of 115 patients. The most common accessory fissure was the inferior accessory fissure (12%). The second most common accessory fissure was the left minor fissure (8%). The right superior accessory fissure (5%), the accessory fissure between the medial and lateral segments of the right middle lobe (5%), and the accessory fissure between the superior and inferior segments of the lingula (5%) were seen in equal frequencies. Also, intersegmental accessory fissures, namely the fissure between the anterobasal and laterobasal of both the right (1%) and the left (2%) lower lobes were detected. We found only one subsegmental accessory fissure.

DISCUSSION AND CONCLUSION

The inferior accessory fissure and the left minor fissure were the most common accessory fissures in our study.

Congenital bronchial abnormalities revisited

Bronchial anatomy is adequately demonstrated with the appropriate spiral computed tomographic technique on cross-sectional images, multiplanar reconstruction images, and three-dimensional reconstruction images. Contrary to the numerous variations of lobar or segmental bronchial subdivisions, abnormal bronchi originating from the trachea or main bronchi are rare. Major bronchial abnormalities include accessory cardiac bronchus (ACB) and "tracheal" bronchus. An ACB is a supernumerary bronchus from the inner wall of the right main bronchus or intermediate bronchus that progresses toward the pericardium. Fourteen ACBs were found in 17,500 consecutive patients (frequency, 0.08%). The term tracheal bronchus encompasses a variety of bronchial anomalies originating from the trachea or main bronchus and directed to the upper lobe. In a series of 35 tracheal bronchi, only eight originated from the trachea, three originated from the carina, and 24 originated from the bronchi. Displaced tracheal bronchi (27 of 35) are more frequent than supernumerary tracheal bronchi (eight of 35). Minor bronchial abnormalities include variants of tracheal bronchus, displaced segmental bronchi, and bronchial agenesis. The main embryogenic hypotheses for congenital bronchial abnormalities are the reduction, migration, and selection theories. Knowledge and understanding of congenital bronchial abnormalities may have important implications for diagnosis, bronchoscopy, surgery, brachytherapy, and intubation.

Tracheal bronchus associated with lung cancer: a case report

Tracheal bronchus is a rarely found congenital bronchial anomaly. It usually originates from the right lateral wall of the trachea at the level < 2 cm above the tracheal bifurcation. The patients usually are asymptomatic, but some may experience recurrent pneumonia, chronic bronchitis, or bronchiectasis. It is very rare for a malignant tumor to grow from this aberrant bronchus. There are only four cases of lung cancer developing from the tracheal bronchus reported in the world literature, and we present a fifth case.

Variation in major pulmonary fissures: incidence in fetal postmortem examinations and a review of significant extrapulmonary structural abnormalities in sixty cases

A retrospective study of 1513 fetal postmortem examination reports from 1967 to 1996 yielded 35 cases with anomalous major pulmonary fissures (2.3%), to which a further 25 cases were added from fetal postmortem examinations performed between 1929 and 1966. Of 60 cases with anomalous fissures, 43 had an absent right horizontal fissure and 8 had a supernumerary left horizontal fissure; the remaining 9 showed various patterns in which one lung lacked major fissures. Histological examination in 29 cases did not reveal any additional pulmonary abnormality and pulmonary maturity was appropriate for gestational age. Additional malformations were present in 40 cases and these were frequently multiple, the most common being central nervous system, cardiovascular, and genitourinary system defects; notable heart malformations (10 cases); hydrocephalus (5 cases); and cystic renal dysplasia (4 cases). Chromosomal abnormalities were demonstrated in six cases although this figure does not reflect their prevalence, as many cases predate the availability of karyotyping. In seven cases, including three with polysplenia syndrome and one with situs inversus totalis, there was evidence of an underlying abnormality of left-right asymmetry, and in 13 cases there was documented pulmonary hypoplasia.

A VATS lobectomy for lung cancer in a patient with an anomalous pulmonary vein: report of a case

A video-assisted right upper lobectomy was successfully performed on a 58-year-old man with an anomalous segmental pulmonary vein. The tumor was a peripherally located adenocarcinoma. The anomalous vein behind the right main bronchus was identified and safely divided. This case emphasized that to perform this procedure successfully, (1) a careful preoperative evaluation of the anatomy, including the presence of any possible vascular and/or bronchial anomalies, is necessary, and (2) if any anatomical structures cannot be determined intraoperatively, a conversion into an open procedure must immediately be undertaken.

Demonstration of a tracheal bronchus by computed tomography

Computed tomography (CT) demonstrated a tracheal bronchus in a young child as well as the associated cystic disease of the right lung. Confirmation of the anatomical bronchial variant was obtained later when the cystic lesion was infected with aspergillus and surgically removed.

Bilateral tracheal bronchi

A case of bilateral tracheal bronchi, first diagnosed at 14 months, is reported in a child who is currently alive and well at more than two years of age. This is only the second such case to be described in the world literature and is the only case to survive the first year of life. A tracheal accessory lung was also present. The varieties of tracheal bronchi are described. The importance of considering this uncommon abnormality in a number of clinical situations is emphasized.

Tracheal bronchus with regional ventilation and perfusion abnormalities

Tracheal bronchus is an uncommon anomaly of the tracheobronchial tree. In the case presented, clinical and pathophysiologic abnormalities were associated with this anomaly. The tracheal bronchus supplied the right upper lobe of the lung. The bronchus intermedius arose directly from the trachea in place of the right main bronchus. It was accompanied by marked regional changes in ventilation and perfusion. We discuss the clinical significance of this unusual anomaly.

Anomalous origin of the anterior segmental bronchus of the right upper lobe

Images

Case report: infantile sub-lobar emphysema and tracheal bronchus

Localised disturbance of aeration in children is as often the result of mucosal swelling due to infection as resulting from an inhaled foreign body. The present report adds another cause: tracheal bronchus. Elucidation of this cause of localised disturbance of aeration usually includes bronchoscopy, the anesthesia and direct trauma involved being highly undesirable if i infection is the cause. The case for limited, careful bronchography, before or instead of bronchoscopy, when the history of foreign body is lacking is presented.