A Case of Situs Inversus Totalis with Lung Cancer Treated Surgically by Using a Double-lumen Endobronchial Tube for the Right Bronchus as Well as 3D-CT Findings

Abstract

Situs inversus totalis is an anatomical anomaly during embliogenesis. As it is characterized by total mirror-image transposition of all viscera across the left-right axis of the body, the surgery for lung cancer requires to control separated lung ventilation and to understand the anatomical structures. Recently we have experienced a case of lung cancer associated with situs inversus totalis treated surgically. The case involved a 68-year-old woman who presented with an abnormal shadow in the chest. A chest x-ray film and a chest CT scan revealed situs inversus totalis and a nodular shadow suggestive of lung cancer in the left upper lobe. The 3D-CT confirmed the structure of the pulmonary bronchovascular trees. In order not to place the bronchial tube or bronchial blocker into the left main bronchus which is shorter than the right one, we performed left upper lobectomy by using a double-lumen endobronchial tube (DLT) for right bronchus. As the 3D-CT findings suggested, the superior truncus of pulmonary artery was found to have branched at the hilus and the A²b, at the interlobar structure, that was the mirror-image structure of branching of the common right pulmonary artery.

In performing surgery of lung cancer with situs inversus totalis, the establishment of separated lung ventilation and good understanding of the bronchovascular structures with 3D-CT are important, but at the same time, attention must be paid to a probable change of three-dimensional structure accompanied by pulmonary collapse.