A case of right lower lobectomy with mediastinal A⁷⁺⁸⁺⁹ branching

Abstract

For successful lung resection in the presence of anatomical anomalies of the pulmonary artery, preoperative computed-tomography is useful. We report a rare case of right lower lobectomy with mediastinal A⁷⁺⁸⁺⁹ branching. A 64-year-old man with a history of surgery for gastric cancer was noted to have an expanding pulmonary nodule in S6 of the right lung. Preoperative three-dimensional computed tomography (3D-CT) revealed mediastinal A⁷⁺⁸⁺⁹ branching from the right main pulmonary artery, passing between the superior and inferior vein and along the mediastinal side of the intermediate bronchus. The main lesion was a solid nodule with a pleural indentation measuring 10 mm. Suspecting metastatic lung cancer or lung cancer (cT1aN0M0), right lower lobectomy (ND1b) was conducted along with partial lung resection of S6 because the histological diagnosis of the tumor was adenocarcinoma based on intraoperative pathological examination. A right mediastinal basal pulmonary artery is a rare anatomical variant, and this is the 6^th case reported in Japan. To prevent intraoperative injury, it is important to accumulate information from accurately interpreted preoperative 3D-CT and plan the surgical procedure while considering anatomical anomalies.