Left Lower Lobectomy in a Patient with Absence of Pulmonary Artery Branching into the Lobe

Author(s):  
Hiromichi Katakura ◽  
Tsuyoshi Shoji
Author(s):  
Madhusudana Narayana ◽  
Nagesh Basavaraj ◽  
Smitha Nagaraju ◽  
Jagmohan Sugnyanasagar Venkataramanappa

Abstract We report a rare case of solitary peripheral pulmonary artery aneurysm in a patient who was evaluated for haemoptysis. Incidentally, his total antibodies were positive for Coronavirus 2019 infection. Patient underwent right lower lobectomy uneventfully. Peripheral pulmonary artery aneurysms arising from segmental or intrapulmonary branches are extremely rare. Untreated, the majority end fatally due to sudden rupture and exsanguination. The purpose of this article is to report our rare case and review the pertinent literature.


2021 ◽  
Author(s):  
Kazuyuki Komori ◽  
Hiroshi Hashimoto ◽  
Kotaro Yoshikawa ◽  
Koji Kameda ◽  
Shinichi Taguchi ◽  
...  

Abstract Background A mediastinal mediobasal segmental pulmonary artery (A7) from the right main pulmonary artery is extremely rare. Case presentation: We have reported a case of a 71-year-old woman with aberrant A7 who underwent right lower lobectomy for lung cancer (cT1bN0M0, stage IA2). Preoperative three-dimensional computed tomography (CT) angiography revealed an aberrant mediastinal A7 from the right main pulmonary artery. Right lower lobectomy and mediastinal lymph node dissection were performed. Intraoperatively, A7 was observed between the superior and inferior pulmonary veins, and at the front of the lower bronchus near the anterior hilum. The artery was carefully dissected from the caudal side after dissection of the inferior pulmonary vein. Then, the lung parenchyma, which was within the fissure due to poor lobulation between the middle and lower lobes, was safely divided. Conclusions Thoracic surgeons need to evaluate CT angiography or enhanced multidetector CT carefully at preoperative conferences and always keep this anomaly in mind.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hirokazu Hamasaki ◽  
Chika Shirakami ◽  
Tatsuya Yamada ◽  
Yamato Motooka ◽  
Kosuke Fujino ◽  
...  

Abstract Background Right sleeve lower lobectomy is rarely performed because pulmonary function of the middle lobe is not spared to the extent of the other lobes and achieving a proper bronchial anastomosis is technically more difficult than other sleeve lobectomies. Case presentation We performed four right sleeve lower lobectomies and had good clinical outcomes using specific technical options, such as telescope anastomosing, pericardiotomy, interlobar dissection between the upper and middle lobes, and angioplasty of the lower pulmonary artery, if needed. Conclusions The cases presented herein demonstrated that a right sleeve lower lobectomy is one option by which to preserve the middle lobe using specific techniques and is thus recommended in select patients.


2020 ◽  
Vol 34 (1) ◽  
pp. 86-90
Author(s):  
Hiroaki Tsunezuka ◽  
Tomoki Nishimura ◽  
Satoru Okada ◽  
Narumi Ishikawa ◽  
Atsuki Uchibori ◽  
...  

Author(s):  
Dario Amore ◽  
Dino Casazza ◽  
Alessandro Saglia ◽  
Pasquale Imitazione ◽  
Umberto Caterino ◽  
...  

Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called “en masse” lobectomy and a way to avoid conversion to thoracotomy.


2021 ◽  

This video tutorial describes a left lower lobectomy performed by the uniportal approach. A single 2-cm incision in the lateral chest wall is used as the utility port. The procedure begins with division of the inferior pulmonary ligament and isolation of the inferior pulmonary vein. This patient has densely adherent interlobar nodes, which are then dissected to demonstrate the interlobar pulmonary artery. Then we proceed to divide the anterior part of the fissure after identifying and safeguarding the lingular branches of the pulmonary artery. This step is followed by the division of the posterior part of the fissure after identification of the posterior branches of the pulmonary artery to the upper lobe. Then we identify the basilar trunk and divide it using endostaplers. Other branches of the interlobar artery are clearly identified, and the apicobasal artery is taken separately. This is followed by division of the inferior pulmonary vein and a systematic mediastinal nodal dissection.


2019 ◽  
Vol 133 (20) ◽  
pp. 2045-2059 ◽  
Author(s):  
Da Zhang ◽  
Xiuli Wang ◽  
Siyao Chen ◽  
Selena Chen ◽  
Wen Yu ◽  
...  

Abstract Background: Pulmonary artery endothelial cell (PAEC) inflammation is a critical event in the development of pulmonary arterial hypertension (PAH). However, the pathogenesis of PAEC inflammation remains unclear. Methods: Purified recombinant human inhibitor of κB kinase subunit β (IKKβ) protein, human PAECs and monocrotaline-induced pulmonary hypertensive rats were employed in the study. Site-directed mutagenesis, gene knockdown or overexpression were conducted to manipulate the expression or activity of a target protein. Results: We showed that hydrogen sulfide (H2S) inhibited IKKβ activation in the cell model of human PAEC inflammation induced by monocrotaline pyrrole-stimulation or knockdown of cystathionine γ-lyase (CSE), an H2S generating enzyme. Mechanistically, H2S was proved to inhibit IKKβ activity directly via sulfhydrating IKKβ at cysteinyl residue 179 (C179) in purified recombinant IKKβ protein in vitro, whereas thiol reductant dithiothreitol (DTT) reversed H2S-induced IKKβ inactivation. Furthermore, to demonstrate the significance of IKKβ sulfhydration by H2S in the development of PAEC inflammation, we mutated C179 to serine (C179S) in IKKβ. In purified IKKβ protein, C179S mutation of IKKβ abolished H2S-induced IKKβ sulfhydration and the subsequent IKKβ inactivation. In human PAECs, C179S mutation of IKKβ blocked H2S-inhibited IKKβ activation and PAEC inflammatory response. In pulmonary hypertensive rats, C179S mutation of IKKβ abolished the inhibitory effect of H2S on IKKβ activation and pulmonary vascular inflammation and remodeling. Conclusion: Collectively, our in vivo and in vitro findings demonstrated, for the first time, that endogenous H2S directly inactivated IKKβ via sulfhydrating IKKβ at Cys179 to inhibit nuclear factor-κB (NF-κB) pathway activation and thereby control PAEC inflammation in PAH.


2005 ◽  
Vol 6 (1) ◽  
pp. 64-64
Author(s):  
A CESARIO ◽  
D ONORATI ◽  
V CARDACI ◽  
S MARGARITORA ◽  
V PORZIELLA ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document