Anomalous right upper lobe venous drainage

Abstract

Lung resections are usually not associated with significant bleeding, but can be fatal, especially in cases of video-assisted thoracoscopic surgery (VATS). Anomalous vascular structures could be a major reason for unexpected bleeding in such surgeries. We present a case of an aberrant upper lobe pulmonary vein that was encountered posterior to the right upper lobe bronchus during a right upper lobectomy via thoracotomy. The anomalous pulmonary vein was identified preoperatively on a computed tomography (CT) scan and hence was looked for before dividing the bronchus. Many centres are adopting the VATS approach for performing lung resections. If an anomalous vein is present posterior to the bronchus, it might be in a blind spot and could be damaged inadvertently, leading to profuse and potentially fatal bleeding. We conclude that the identification of anomalous vascular structures prior to surgery with the help of CT helps in avoiding adverse outcomes.

Accessory right V6 behind the bronchus intermedius during VATS right upper lobectomy

“…The advent of VATS (video-assisted thoracic surgery), adopted with such enthusiasm also for major lung resections, has revived interest in these vascular anomalies that can lead to serious unexpected bleeding during surgery when not recognized [3,5,6]. Minimally invasive approaches in thoracic surgery have been widely appreciated thanks to well documented early postoperative benefits but some limits, such as reduced tactile sensation and restricted range of motion [7], could be an obstacle to safe surgical dissection in presence of vascular variations missed preoperatively. Reported causes of conversion to thoracotomy during VATS lobectomy are not only fused interlobar fissure, calcified hilar adenopathy, oncologic problems but also vascular anomalies [8,9].…”