Lung Cancer Treated under Uniportal Video-assisted Thoracic Surgery in a Patient with an Anomalous Posterior Segment Pulmonary Vein in the Upper Lobe of the Right Lung—A Case Report—

Abstract

Anomalous bifurcation of the right superior pulmonary vein is an important anomaly that should be recognized in respiratory surgery for the safe performance of surgery. We report a case in which thoracoscopic pulmonary lobectomy was safely performed using preoperative three-dimensional computed tomography (3D-CT) imaging. A 73-year-old man, during a follow-up of COPD, showed to have an abnormal lesion in the right lung at a chest X-ray. Chest computed tomography showed a 1.8-cm-diameter tumor in the right pulmonary upper lobe. Preoperative contrast-enhanced computed tomography (CT) and 3D-CT imaging showed a break in the right pulmonary vein passing dorsal to the right main bronchus and flowing into the right upper pulmonary vein (V2). The patient underwent uniportal video-assisted thoracoscopic right upper lobectomy for lung adenocarcinoma. First of all, we treated the dorsal V2, followed by the vessels and bronchus. The dorsal V2 could be confirmed under uniportal vision and safely treated. In this case, we could identify the dorsal V2 preoperatively that enabled us to make a plan to create an additional port, if the only uniportal method was insufficient. As a result, we could perform a safe surgery by only uniportal approach. There are a variety of anomalous runs of the pulmonary arteries and veins. Here, we report a case of lung cancer in a patient with an anomalous V2, supported by preoperative 3D-CT to identify the anatomical relationships between the vessel and bronchus.