A Case of Lung Cancer Associated with a Displaced Right B² Bronchus

Abstract

A 67-year-old man was found to have a 1.5-cm nodule in the right upper lobe of the lung at a medical checkup. A chest CT scan showed a solid lesion at the right S¹. Accordingly, we planned to conduct bronchoscopy. Bronchoscopy revealed right B¹⁺³ branching in the right upper lobe and B² branching from lateral side of the middle lobar bronchus of the right truncus intermedius. We could not diagnose the case based on bronchoscopy findings, and following thoracoscopic partial resection of the lung, pulmonary adenocarcinoma was diagnosed. Exploration of the whole body revealed no metastases to other organs, and the diagnosis of cT1bN0M0 stage 1A2 was made. Later right upper lobectomy and mediastinal lymph node dissection were performed. Incomplete lobulation was identified, but there was no anomalous branching of the pulmonary arteries and veins. We confirmed that a slightly thick B² had branched from the periphery of the truncus intermedius, and the bronchial stumps were closed by using a stapler. In treating lung cancer with anomalous branching of the bronchus, we are required careful attention at lung resection. We present our case with some bibliographical comments.