Abstract
The patient was a 37-year-old woman. In the course of follow-up for SLE, pulmonary arteriovenous fistula was pointed out by means of chest X-P and CT scan. She was transferred to this ward for fear of aggravation. Cyanosis was noted on the whole body. Chest CT scan and angiography revealed a phyma as large as 45×26mm bulged partly into the lobe at right S6. Each one of A6 and V6 was dilated, being as independent inflow and outflow vessels. Since the patient was young, it was planned to perform enucleation. During the operation it was noted that the phyma bulged into the upper lobe from the lower showing turbulent flow. The thick A6 and V6 were exposed and ligated at their roots, but the phyma was not constricted and venous blood spurted out, suggesting the presence of another inflow vessel. As hemorrhage persisted while we continued enucleation, the mode of operation was changed to segmentectomy of S6. Resected material of S6 revealed blood vessels bifurcated from A7, as if branch vessels in both segments were gathering into the phyma. After the surgery no complications occurred, cyanosis subsided, and blood gas was normalized. Physiologically it was a phyma present mainly in the vein.
We had great difficulties in evaluating those thick inflow blood vessels preoperatively in this case. Accordingly, it is considered safe to employ segmentectomy for a large phyma with thick inflow vessels.
