Multiple variations in pulmonary veins during a thoracoscopic right lower lobectomy: A case report

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.

Download Full-text

Bronchopleural and pulmonary arterial fistulas after right lower lobectomy; a case report.

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.9.717 ◽

1995 ◽

Vol 9 (6) ◽

pp. 717-720

Author(s):

Hiroshi Saito ◽

Satoshi Tabata ◽

Yoshihiko Arano ◽

Shin Nagao

Keyword(s):

Case Report ◽

Lower Lobectomy ◽

Pulmonary Arterial ◽

Right Lower Lobectomy

Download Full-text

Robotic-Assisted Video-Thoracoscopic Completion Right Pneumonectomy for Recurrent Non-small Cell Lung Cancer After Prior Right Lower Lobectomy: A Case Report

CHEST Journal ◽

10.1378/chest.1836721 ◽

2014 ◽

Vol 145 (3) ◽

pp. 37A

Author(s):

Eric Toloza ◽

Anna Cheng ◽

Carla Moodie ◽

Vanessa Prowler ◽

Joseph Garrett

Keyword(s):

Lung Cancer ◽

Case Report ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Robotic Assisted ◽

Lower Lobectomy ◽

Right Lower Lobectomy

Download Full-text

Lung cancer with partial anomalous pulmonary venous connection in a different lobe: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01505-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hikaru Watanabe ◽

Naoki Kanauchi ◽

Kouhei Abe ◽

Soumei Matsuo

Keyword(s):

Lung Cancer ◽

Pulmonary Veins ◽

Lower Lobe ◽

Right Heart ◽

Lower Lobectomy ◽

The Right ◽

Anomalous Pulmonary Venous Connection ◽

Right Lower Lobectomy ◽

Circulatory Dynamics

Abstract Background Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure. Case presentation A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery. Conclusions We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

Download Full-text

Lung cancer with partial anomalous pulmonary venous connection in a different lobe: A case report

10.21203/rs.3.rs-88153/v1 ◽

2020 ◽

Author(s):

Hikaru Watanabe ◽

Naoki Kanauchi

Keyword(s):

Lung Cancer ◽

Pulmonary Veins ◽

Lower Lobe ◽

Right Heart ◽

Lower Lobectomy ◽

The Right ◽

Anomalous Pulmonary Venous Connection ◽

Right Lower Lobectomy ◽

Circulatory Dynamics

Abstract Background: Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure.Case presentation: A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery.Conclusions: We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

Download Full-text