A case of resected lung cancer with displaced anomalous left upper division bronchus and anomalous left pulmonary artery

Abstract

A 68-year-old man underwent a thoracoscopic lobectomy for right middle lobe lung cancer (pTis, Stage 0) at 64 years of age. Three years later, a partly solid nodule on the mediastinal side of the left upper lobe (S3) was detected. Due to progressive enlargement of the nodule (largest diameter: 22 mm, solid component diameter: 6 mm), primary lung cancer was suspected and thoracoscopic left upper segmentectomy was planned.

Preoperative three-dimensional computed tomography (3D-CT) revealed a displaced left upper division bronchus, with independent branching of the left lingular division bronchus. This finding was confirmed on bronchoscopic examination. Further, on 3D-CT, the pulmonary artery (PA) had an abnormal distribution, with A6 arising from the left main PA at the level of A3, with more proximal than normal anatomy. A6 shared a common trunk with A1+2b and A1+2c. The displaced upper division bronchus passed the dorsal side of the left main PA.

Intraoperative findings revealed hyperlobulated areas between the upper and lingular divisions. We carefully examined the anatomical relationship between the bronchus and PA based on preoperative CT, and finally, thoracoscopic left upper segmentectomy was successfully completed. Histological diagnosis of the tumor was adenocarcinoma (pT1mi, pStage IA1).