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

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.

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

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.

Right Lower Lobectomy With Middle Lobe Preservation After Right Upper Lobectomy in Lung Cancer of the Right Lower Lobe

2013 ◽  
Vol 96 (6) ◽  
pp. 2227-2230 ◽  
Author(s):  
Naohiro Taira ◽  
Tsutomu Kawabata ◽  
Atsushi Gabe ◽  
Takaharu Ichi ◽  
Kazuaki Kushi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lower Lobe ◽  
Middle Lobe ◽  
Lower Lobectomy ◽  
The Right ◽  
Middle Lobe Preservation ◽  
Right Lower Lobectomy

scholarly journals An aberrant mediastinal mediobasal segmental pulmonary artery in a patient with lung cancer undergoing right lower lobectomy: a case report

2021 ◽  
Author(s):  
Kazuyuki Komori ◽  
Hiroshi Hashimoto ◽  
Kotaro Yoshikawa ◽  
Koji Kameda ◽  
Shinichi Taguchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pulmonary Artery ◽  
Ct Angiography ◽  
Multidetector Ct ◽  
Mediastinal Lymph Node ◽  
Pulmonary Veins ◽  
Main Pulmonary Artery ◽  
Lower Lobectomy ◽  
The Right ◽  
Right Lower Lobectomy

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.

scholarly journals Management of a primary cardiac leiomyosarcoma in a young woman

2021 ◽  
Vol 29 (2) ◽  
pp. 267-270
Author(s):  
Mehmet Akif Önalan ◽  
Ahmet Demirkaya ◽  
Kemal Behzatoglu ◽  
Ersin Erek
Keyword(s):  
Pulmonary Veins ◽  
Tumor Resection ◽  
Complete Tumor Resection ◽  
The Right ◽  
Tumor Remnant ◽  
Invasive Techniques ◽  
Right Lower Lobectomy ◽  
Pathological Confirmation ◽  
Complete Tumor

Cardiac leiomyosarcoma is an extremely rare tumor with a poor prognosis. An 18-year-old female patient was admitted to our clinic with a left atrial leiomyosarcoma extending to the right lower pulmonary veins. We performed complete tumor excision by the right anterolateral mini-thoracotomy approach using minimally invasive techniques. After pathological confirmation of the tumor, right lower lobectomy was performed with the same incision one week later to prevent recurrence. Although no tumor remnant was found in the lobectomy specimen, adjuvant chemotherapy was started. No recurrence was detected during the 12-month follow-up. In conclusion, the right submammarian minithoracotomy approach has the advantages of its less invasive nature and suitability for complete tumor resection with lobectomy.

Four arms robotic right lower lobectomy for giant bullous emphysema localised in the right lower lobe, complicated by chronic inflammatory status

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 053-053
Author(s):  
Alessandro Pardolesi ◽  
Luca Bertolaccini ◽  
Jury Brandolini ◽  
Filippo Tommaso Gallina ◽  
Pierluigi Novellis ◽  
...  
Keyword(s):  
Lower Lobe ◽  
Lower Lobectomy ◽  
Inflammatory Status ◽  
The Right ◽  
Right Lower Lobectomy

scholarly journals Right Upper Lobe Partial Anomalous Pulmonary Venous Connection

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Tourmousoglou ◽  
Christina Kalogeropoulou ◽  
Efstratios Koletsis ◽  
Nikolaos Charoulis ◽  
Christos Prokakis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Right Atrium ◽  
Venous Return ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Systemic Vein ◽  
Anomalous Pulmonary Venous Return ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer.

scholarly journals Stapling of an endobronchial suction tube with the bronchus during robot-assisted right lower lobectomy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroto Tanaka ◽  
Teruhiro Aoki ◽  
Makoto Oda ◽  
Yoshimasa Inoue
Keyword(s):  
Thoracic Surgery ◽  
Intraoperative Complications ◽  
Clinical Stage ◽  
Lower Lobe ◽  
Robot Assisted ◽  
Bronchial Stump ◽  
Suction Tube ◽  
Lower Lobectomy ◽  
The Right ◽  
Right Lower Lobectomy

Abstract Background Troubleshooting intraoperative complications requires careful management, and the safest technique should be chosen. We recently experienced a unique intraoperative bronchial complication during pulmonary lobectomy in robot-assisted thoracic surgery (RATS). There is no consensus on whether to continue RATS or convert to a more familiar technique, such as video-assisted thoracic surgery (VATS) or thoracotomy, for intraoperative complications that occur during RATS, and the decision should be determined individually. Case presentation A 74-year-old woman with primary lung adenocarcinoma (clinical stage IA2) underwent robot-assisted right lower lobectomy under one-lung ventilation and CO2 insufflation. Intraoperatively, the anesthesiologist placed the endobronchial suction tube in the right bronchus with intention of maintaining the right lung collapse, which was simultaneously stapled with the right lower bronchus during the right lower lobe bronchial closure using a robotic stapler. During robot-assisted manipulation, we removed the staples involved with the suction tube, one by one, using robotic-arm forceps and sutured the partially opened stump. Subsequently, the bronchial stump was covered with a pedicled pericardial fat pad. The postoperative course was uneventful, and the patient developed no complications when followed up 8 months after discharge. Hence, we could rectify this intraoperative bronchial complication using a robot-assisted technique and avoid conversion to VATS or thoracotomy. Conclusion The precise manipulation techniques in RATS contributed to facilitate the successful execution of surgical procedures, such as staple removal and re-suturing of the bronchial stump and may be a useful as a method for such troubleshooting such intraoperative complications.

scholarly journals How to avoid en masse lobectomy using VATS technique in presence of hilar fibrosis

2021 ◽  
Author(s):  
Dario Amore ◽  
Dino Casazza ◽  
Alessandro Saglia ◽  
Pasquale Imitazione ◽  
Umberto Caterino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Lower Lobe ◽  
Lower Lobectomy ◽  
Challenging Issue ◽  
Thoracoscopic Lobectomy ◽  
Increased Risk ◽  
The Right ◽  
Segmental Arteries ◽  
Right Lower Lobectomy

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.

scholarly journals A Case Report Looking at An Incidental Finding of A Partial Anomalous Pulmonary Venous Connection (PAPVC) Using Magnetic Resonance Angiography (MRA)

2018 ◽  
Vol 6 (1) ◽  
pp. 28-30
Author(s):  
Iqra Qamar ◽  
Mohammad Waleed
Keyword(s):  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Multimodality Imaging ◽  
Incidental Finding ◽  
Pulmonary Veins ◽  
Brachiocephalic Vein ◽  
St Elevation ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

Background: Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital defect where one or more of the pulmonary veins drain to the right atrium or its tributaries. This may cause a left to right shunt (LTRS) which may need surgical management. This case looks at a 58-year-old lady  with a background of Non-­ST elevation myocardial infarction (NSTEMI) and co-­morbidities, who presented with central chest pain. Cardiac magnetic resonance angiogram (MRA) was used in the  diagnosis and management of her PAPVC. Results: On MRA an incidental finding of PAPVC was found (left upper pulmonary vein drained into brachiocephalic vein) creating a LTRS which wasn’t substantial (Qp/Qs <1.5). Delayed hyper-enhancement of the septal regions indicated a myocardial infarction, however the right and left ventricles remained unremarkable. Despite being asymptomatic, this patient was followed up, with informed consent, and if symptoms developed, she would be considered for PAPVC surgery. Conclusion: Studies showed PAPVC patients developing symptoms or LTRS as candidates for operation. However, the issue lied in using multimodality imaging to diagnose the PAPVC, as one modality was insufficient. Physicians should be aware of rare anomalies like PAPVC and should follow up these patients closely in case of worsening of the LTRS, in which case surgical correction may be possible. Overall, PAPVC i) can be overlooked ii) diagnosis requires multimodality imaging iii) constant follow up and iv) may be operable.

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