Case of thoracoscopic right upper lobectomy for lung cancer with tracheal bronchus and a pulmonary vein variation

En Bloc Right Upper Bilobectomy For a Patient With Incomplete Minor Fissure and Multiple Anomalies of the Right Superior Pulmonary Vein

Variations in the anomaly of the right superior pulmonary vein can lead to perioperative complications if misunderstood. Additionally, incomplete fissures increase the complexity of performing pulmonary anatomical resection. Therefore, accurate preoperative anatomical assessment using three-dimensional computed tomography is crucial for ensuring safe surgery. We herein report a case of en bloc right upper bilobectomy via uniportal video-assisted thoracic surgery in a patient with an incomplete minor fissure and a complex anomaly of the right superior pulmonary vein.

Different anatomical variations in the anterior segment of the right upper lung

During a routine physical examination three years ago, a 47-year-old woman received a diagnosis of a nodule in her right upper lung. Since then, she has been regularly attending outpatient clinic appointments for follow-up. Over time, the nodule has shown gradual growth, leading to a suspicion of lung cancer. Through the use of enhanced CT imaging, a three-dimensional reconstruction was performed to examine the bronchi and blood vessels in the patient's chest. This reconstruction revealed several variations in the anatomy of the anterior segment of the right upper lobe. Specifically, the anterior segmental bronchus (B3) was found to have originated from the right middle lung bronchus. Additionally, the medial subsegmental artery of the anterior segmental artery (A3b) and the medial segmental artery (A5) were observed to share a common trunk. As for the lateral subsegmental artery of the anterior segmental artery (A3a), it was found to have originated from the right inferior pulmonary trunk. Furthermore, the apical subsegmental artery of the apical segmental artery (A1a) and the posterior segmental artery (A2) were found to have a shared trunk.

Abnormal origin of the right posterior segmental bronchus: case report and literature review

BACKGROUND

With the increasing availability of chest computed tomography (CT), the detection of small pulmonary nodules has become more common, facilitating the development of lung segmental resection. However, anatomical variations of the bronchi are common, particularly in the right upper lobe of the lung.

CASE PRESENTATION

We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung. Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe. However, intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe, further showing that the bronchi of the posterior segment of the right lung opened into the bronchus intermedius. The procedure was completed uneventfully. Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius.

CONCLUSIONS

This rare case highlights the importance of 3D reconstruction to guide accurate segmentectomy in patients with anatomic variations.

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.

Thoracoscopic Segmentectomy for Right Upper Lobe with Unique Anatomic Variation

Combined variation of bronchus and pulmonary vein is rare. We report the case of a 32-year-old man with lung adenocarcinoma in whom three-dimensional-computed tomography bronchography and angiography displayed a unique anatomic variation in the right upper lobe. The posterior subsegmental bronchi originated from the apical segmental bronchus and the anterior segmental bronchus, respectively; the apical subsegmental vein shared a trunk with the posterior subsegmental vein. Based on this discovery, combined pulmonary segmentectomy was performed accurately.

Rare location and drainage pattern of right pulmonary veins and aberrant right upper lobe bronchial branch: A case report

BACKGROUND

Complex aberration in lung is rare, which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery, and result in sever complication like pulmonary congestion or atelectasis.

CASE SUMMARY

A 44-year-old female was admitted for a ground glass nodule (24 mm in diameter) in her right upper lobe. Video-assisted thoracoscopic (VATS) right upper lobectomy with lymph nodes dissection was performed. During operation, we simultaneously identified extremely rare aberrations of right preeparterial bronchus, right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium in this patient. The patient was well recovered and discharged at the postoperative-day 4.

CONCLUSION

Preoperatively, three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively. During lung surgery, if anatomic aberration is suspected, careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.

VATS right apical segmentectomy for lung cancer in a patient with tracheal bronchus

INTRODUCTION

A tracheal bronchus is rarely observed, occurring in only 1% of all patients who undergo thoracic surgeries. We rarely encounter lung cancer in a patient with a tracheal bronchus; however, it is essential to know the distinctive perioperative management strategy for patients with a tracheal bronchus.

CASE PRESENTATION

We report a 72-year-old man with lung cancer located in the right apical segment supplied by a tracheal bronchus. Annual chest computed tomography performed as follow-up after colon cancer resection showed an enlarging pulmonary nodule with pure ground-glass opacity, which was suspected to be lung adenocarcinoma. The nodule was located in the right apical segment. The apical segment was independently supplied by a single pulmonary artery superior trunk and a tracheal bronchus that branched directly from the trachea at 1.2 cm above the carina. The pulmonary vein branching pattern was uncommon in that the central vein that usually runs through B2 (posterior bronchus) and B3 (anterior bronchus) was missing. The patient underwent video-assisted thoracoscopic apical segmentectomy under one-lung ventilation using a left-sided double-lumen tube.

DISCUSSION

Anomalous venous return accompanied with tracheal bronchus has been described in some reports. Since pulmonary vein is important during segmentectomy, the surgeon should pay particular attention to the venous return.

CONCLUSION

Preoperative three-dimensional graphic imagery helped us accurately identify the anatomical anomaly to enable the successful segmentectomy in a patient with a tracheal bronchus. We review the relevant literature regarding the perioperative management of patients with a tracheal bronchus.

Unusual pulmonary vein variant in a patient with right upper lobe lung cancer

It is essential to understand individual pulmonary anatomy, and the relationship between the tumor and surrounding organ, when lung resection is conducted. Recently, many anomalous pulmonary venous variations have been detected using three-dimensional computed tomography (3D-CT). Herein, we report the case of a 62-year-old women with lung cancer and an anomalous right upper lobe pulmonary vein that drained into the left atrium between the pulmonary artery and bronchus. Preoperative 3D-CT clearly demonstrated the anomalous pulmonary vein, and we safely performed lung resection by thoracoscopic surgery. Therefore, 3D-CT images can help ensure the safety of patients with aberrant vasculature during lung resection.

An extremely rare case with right superior pulmonary vein translocation

Background

There have been a number of reports on pulmonary venous anomalies. However, most of the reports focused on the anatomical branching pattern of the peripheral pulmonary veins.

Case presentation

We report a 75-year-old female whose right superior pulmonary vein V1 existed dorsal to the right main pulmonary artery and V2+3 existed dorsal to V4+5. Thus, we could not find V1 and V2+3 in the hilum just after a thoracotomy to perform right upper lobectomy for lung cancer. Thus, the right main pulmonary artery and the superior trunk (A1+3) were exposed without cutting the superior pulmonary vein.

Conclusion

There has been no report so far regarding this type of pulmonary vein translocation. Preoperative three-dimensional computed tomography images were helpful to identify this variant.

Combined Ectopic Variation of the Right Upper Pulmonary Vein and Bronchus

Ectopia of the right upper pulmonary vein (RUV) is rare and sometimes combined with tracheal bronchus. Such anomalies can affect surgical procedures. We report the case of a 66-year-old woman with lung cancer in which preoperative three-dimensional computed tomography reconstruction and intraoperative images displayed a combined ectopic variation of the RUV and bronchus. The RUV was absent from the anterior hilum, but instead was present in the superior and posterior hilum dispersedly. In addition, the right upper lobe bronchus was ectopic to the lower edge of the "bronchus intermedius." Based on this discovery, video-assisted thoracoscopic lobectomy was successfully performed.

Anomalous right upper lobe pulmonary veins draining posterior to the pulmonary artery

The anatomy of pulmonary vessels varies. The right upper pulmonary vein usually drains in front of the pulmonary artery to the left atrium. We herein describe a case of the right upper lobe pulmonary vein draining posterior to the pulmonary artery and absent right upper lobe pulmonary vein in the ventral hilum. A 64-year-old woman suspected to have lung cancer and scheduled for surgery underwent pre-operative three-dimensional computed tomography (3D-CT), which revealed that pulmonary vessels V1 + 3 and V2 drain posteriorly to the pulmonary artery. Video-assisted right upper lobectomy was performed because the patient was diagnosed with lung adenocarcinoma through intraoperative pathologic analysis, and all the pulmonary vessels were identified correctly during the operation. Despite the limited surgical field of video-assisted lobectomy, the operation was performed safely because the pre-operative 3D-CT assessment revealed the anatomy of the anomalous pulmonary vessels, helping us avoid missing any anomaly and vessel injury.

A rare anomaly of the right superior pulmonary vein: Report of a case

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We experienced a an extremely rare anomaly of the right superior PV.

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Contrast-enhanced three-dimensional CT (3D-CT) showed that the right superior PV ran abnormally between the right main pulmonary artery (PA) and the right main bronchus.

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The anomaly reported in the present case has been reported in only one case report.

Introduction

Although there are a lot of variations of pulmonary veins (PVs) including dangerous type that could cause serous complications during the surgery, limited information has been reported about these variations. We have experienced an extremely rare anomaly of the right superior PV.

Presentation of case

A 74-year-old man patient with right lung cancer visited our hospital. Chest computed tomography (CT) revealed a pulmonary nodule in the right lower lobe. Contrast-enhanced three-dimensional CT (3D-CT) showed that the right superior PV ran abnormally between the right main pulmonary artery (PA) and the right main bronchus. We performed right lower lobectomy and systematic nodal dissection. The operative findings confirmed that the right superior PV ran abnormally same as 3D-CT.

Discussion

In most reported cases, anomalous PVs pass behind the right bronchi or into the roof of the left atrium. The anomaly reported in the present case has been reported in only one case report. This case suggests that the space between the right main PA and the right main bronchus is not always safe for dissection.

Conclusion

Preoperative 3D-CT is useful for avoiding unexpected bleeding.

[Thoracoscopic lobectomy for the treatment of tracheal bronchus. A pediatric case report]

BACKGROUND

Tracheal bronchus is considered a rare, congenital anomaly, which implies the abnormal origin of a bronchus. When related to repetitive infections the bronchus must be resected, usually via an open procedure.

OBJECTIVE

The aim of this paper is to present the case of a patient with tracheal bronchus of the upper right lobe who presented with repetitive pneumonias. Additionally, this text intends to expose the methodology for its diagnosis and surgical resolution through a thoracoscopic lobectomy.

CLINICAL CASE

One year old female patient who presented with the disorder at two months of age. The patient presented with constant coughing and persistent fever alongside repetitive pneumonias in the upper right lobe. In order to discard the possibility of gastroesophageal reflux, a bronchoscopy and a panendoscopy of the digestive tube were conducted. The aforesaid procedure demonstrated the existence of a tracheal bronchus located in the right lobe, with functional bronchial segmentation. With these findings and due to the presence of repetitive infections, an apical right lobectomy was performed through a thoracoscopy, with favourable results.

CONCLUSIONS

Tracheal bronchus is a rare anomaly that on many occasions is asymptomatic; nonetheless, when related to repetitive infections, a lobectomy must be carried out to avoid further pulmonary damage. This can be done through a thoracoscopy, as was the case with our patient. When treating these patients, it is worth considering they tend to have a different anatomy and to consider the ease at which they can sustain severe inflammation due to repetitive infections.

Lung adenocarcinoma with anomalous bronchi and pulmonary veins preoperatively identified by computed tomography

A 69-year-old woman visited our hospital complaining of right chest pain. Chest computed tomography showed a 55 × 45 mm tumor in the right upper lobe. Bronchoscopy revealed displaced anomalous B ¹ and B ²⁺³ arising from the right main bronchus, and the patient was diagnosed with lung adenocarcinoma by transbronchial lung biopsy from the displaced B ²⁺³ . Three-dimensional computed tomography with multiplanar reconstruction revealed a displaced anomalous B ¹ and B ²⁺³ branching directly from the right main bronchus, respectively, and abnormal distribution of the aberrant pulmonary vein (V ² ) descended dorsally to the right main bronchus and emptied into the left atrium. Video-assisted right upper lobectomy with nodal dissection was successfully performed. Attention should be paid to the anomalous bronchus and pulmonary vessels for safer lung cancer operations, especially for video-assisted thoracic surgery.

Thoracoscopic right posterior segmentectomy of a patient with anomalous bronchus and pulmonary vein

A 39-year-old woman was admitted to our hospital for a pure ground-glass opacity that had been detected in the right lung during a regular examination. A computed tomography scan showed a pure ground-glass opacity beneath the pleura of the right upper lobe of the lung that had enlarged over time. As a consequence, a lung adenocarcinoma was suspected. Meanwhile, three-dimensional computed tomography scans revealed a tracheal bronchus originating directly from the lateral wall of the trachea. The patient consequently underwent posterior segmental resection and mediastinal lymph node sampling by video-assisted thoracic surgery. During surgery, in addition to the tracheal bronchus, a variable central vein was found entering the left atrium dorsal to the right pulmonary artery trunk. We submit that, to the best of our knowledge, this is the first case of its kind ever reported.