Abstract
The patient, a 64-year-old woman with a primary complaint of dyspnea, was examined at a local hospital, found to have abnormal thoracic opacity, and referred to this hospital. Three-dimensional computed tomography angiography showed an anomalous artery originating from the descending aorta and flowing into the left lung basal segment with a large aneurysm, approximately 28 mm in diameter. The lung field clearly showed vasodilation and decreased transparency. These signs were associated with calcification of, and thrombus formation in, the arterial wall. The branch of the pulmonary artery leading to the basal segment was absent, the routes of the inferior pulmonary vein and bronchi were normal, and the condition was judged to be anomalous systemic arterial supply to the basal segment of the left lung. In order to prevent the risk of hemorrhage associated with transection of an abnormal aneurysm, the first step was stent-graft insertion in the descending aorta, followed by video-assisted thoracoscopic left lower lobectomy and transection of the abnormal artery.
Stent-graft insertion is a novel treatment method for an aortic aneurysm, but blood flow to the abnormal aneurysm associated with anomalous systemic arterial supply to the basal segment of the left lung was blocked by the stent graft in this case. This enabled transection of the abnormal artery and pulmonectomy to be carried out safely, making it a very useful technique. Including the present patient, only two cases of stent graft use have been reported to treat this condition. Thus, we consider this to be a very important case study.
