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

Abstract

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 S 1+2 and S 6 segments in the left lung. The three-dimensional (3D) CT with multiplanar reconstruction showed that B 1+2 b+c passed to the dorsal side of the left main pulmonary artery (PA), which was considered a displaced bronchus. The branch of A 6 arose from the left main PA at the level of the branches of A 3 and A 1+2 , more proximal than the normal anatomy, and passed to the dorsal side of a displaced B 1+2 b+c. The branch of V 1+2 passed between B 6 and the bronchus to the basal segment and joined V 6 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 S 1+2 b+c and S 6 by VATS was performed safely. Then there were accessory fissures between S 1+2 and S 3 and between S 6 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 superior segmentectomy for a patient with displaced anomalous apicoposterior branches of the pulmonary vein and bronchus: a case report

“…Preoperative, three-dimensional, multi-dissector CT angiography allows visualization of pulmonary vasculature and bronchi anatomy. Akiba et al recommended the use of this technology for surgical planning in patients undergoing an anatomical resection due to lung cancer [ 6 ]. Ohtaka et al described that VATS segmentectomy was performed for a lung abscess patient with a displaced subsegmental bronchus and recommended a preoperative 3D CT may be helpful for identifying anatomical anomalies [ 7 ].…”

“…We report the case of a patient diagnosed with a part-solid lung cancer in her lower left lobe and with a displaced apicoposterior branch of the bronchus (B 1+2 ) and vein (V 1+2 ). The patient underwent a left superior segmentectomy (S 6 ). The patient's anatomy was well understood preoperatively due to the use of three-dimensional CT images.…”

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

“…There have been three reports on video‐assisted thoracoscopic lobectomy in patients with anomalous bronchi and vascular abnormalities to date 8‐10 . We occasionally encounter patients with bronchial and vascular abnormalities that occur concurrently, and conventional open lobectomy is often the treatment of choice for such patients to avoid intraoperative complications.…”

VATS right posterior segmentectomy with anomalous bronchi and pulmonary vessels: a case report and literature review

“…With the popularization of chest computed tomography (CT), the discovery of small pulmonary nodules is increasingly common, which also promotes the progress of segmentectomy [1,2]. As reported in the previous cases, the anatomic structure of the pulmonary segment is sometimes variable [3][4][5]. The public's attention is now shifting to how to achieve an accurate anatomic segmentectomy.…”