Thoracoscopic Right Posterior Segmentectomy of a Patient With Anomalous Bronchus and Pulmonary Vein

摘要

A 39-year-old woman was admitted to our hospital for a pure ground-glass opacity that had been detected in the right lung during a regular examination. A computed tomography scan showed a pure ground-glass opacity beneath the pleura of the right upper lobe of the lung that had enlarged over time. As a consequence, a lung adenocarcinoma was suspected. Meanwhile, three-dimensional computed tomography scans revealed a tracheal bronchus originating directly from the lateral wall of the trachea. The patient consequently underwent posterior segmental resection and mediastinal lymph node sampling by video-assisted thoracic surgery. During surgery, in addition to the tracheal bronchus, a variable central vein was found entering the left atrium dorsal to the right pulmonary artery trunk. We submit that, to the best of our knowledge, this is the first case of its kind ever reported.CTSNet classification:10Tracheal bronchus is a rare variation that refers to an abnormal bronchus that comes directly off the lateral wall of the trachea and supplies ventilation to the upper lobe. Here, we report an uneventful thoracoscopic right posterior segmentectomy with the tracheal bronchus and the abnormal vein.A 39-year-old woman with no history of smoking was admitted to our hospital because of a pure ground-glass nodule that was detected in the right lung during a routine physical examination. Computed tomography (CT) scan suggested a 7?× 8 mm pure ground-glass nodule beneath the pleura of the right upper lobe, with no significant enlargement of the hilar, and mediastinal lymph nodes found bilaterally. Three-dimensional CT demonstrated that the apical and anterior segmental bronchus directly originated from the main trachea, and the posterior segmental bronchus originated from the right main bronchus (Fig 1, Fig 2). The patient was found to be asymptomatic with normal physical examination results and blood test analysis. No distant metastases were observed by bone radioisotopic scanning.Fig 1Chest computed tomography revealed the pure ground-glass nodule (red arrow) and the anomalous tracheal bronchus (blue arrow).View Large Image | Download PowerPoint SlideFig 2Three-dimensional computed tomography revealed the pure ground-glass nodule (red arrow) and the anomalous tracheal bronchus (blue arrow).View Large Image | Download PowerPoint SlideIntraoperative scanning showed the apical and anterior segmental bronchus directly originated from the right wall of the trachea and the posterior segmental bronchus originated from the right main bronchus, as preoperatively expected. Initially, we cut the posterior segmental bronchus (5 mm away from its opening) using an endoscopic linear stapler from the posterior hilum. The posterior ascending artery was then easily identified and isolated. As we had dissected the parabronchus tissue along the isolated distal posterior segmental bronchus course, the recurrent artery was concordantly confirmed. Then the anomalous central vein [