Dangerous mediastinal basal pulmonary artery during left upper lobectomy

Shibano, Tomoki; Endo, Shunsuke; Tetsuka, Kenji; Kanai, Yoshihiko

doi:10.1510/icvts.2011.274050

Cited by 13 publications

(8 citation statements)

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“…The present case corresponded to type I. Several reports described that the basilar segmental PA branched from the left main PA [6, 7]. However, there is no report of case involving both the congenital first rib hypoplasia and the mediastinal lingular and basal PA.…”

Section: Discussionsupporting

confidence: 64%

The first rib hypoplasia and the aberrant pulmonary artery branch detected by three-dimensional computed tomography in a surgical case with apical lung cancer, a case report

et al. 2017

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BackgroundThe complete resection is one of the most crucial requirements to achieve favorable outcomes in oncologic surgery. The apex of the lung is surrounded complicatedly by the clavicle, the first rib, the subclavian artery and vein, and the brachial plexus. Therefore, the image information especially about the infiltration of adjacent anatomic structures, facilitates the surgery in the apical lung cancer.Case presentationA 70-year-old man presented at our hospital with a computed tomography (CT) scan showing a tumor at the left lung apex that infiltrated the chest wall. Two anatomical anomalies were found, which were the first rib hypoplasia and the aberrant pulmonary artery branch. The three-dimensional (3D) CT enhanced with using bolus tracking method, simultaneously revealed that the subclavian vessels existed between the clavicle and the second rib, and the left lingual pulmonary artery and the ventrobasal pulmonary artery diverged from the left main pulmonary artery as the first branch. We diagnosed the tumor as a primary lung squamous cell carcinoma that infiltrated the second rib, because sputum cytology suggested squamous cell carcinoma. Left lung upper lobectomy with lymph node dissection and chest wall resection (the second and third ribs) were performed with caution for the anatomical anomalies. The pathological diagnosis was pleomorphic carcinoma (5.0 × 3.0 × 1.9 cm) that invaded the second costal bone, and the pathological stage was confirmed to be pT3N0M0. Pathologically curative resection was accomplished. The patient was discharged from the hospital on 10 days after surgery.ConclusionThe 3D-CT precisely detected the anomalous structure consisted with the clavicle, the second rib, the subclavian artery and vein, the aberrant pulmonary artery branch. In the present case with the apical lung cancer, the evaluation of the anatomical structure via 3D-CT facilitated to achieve a pathological complete resection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0199-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 64%

The first rib hypoplasia and the aberrant pulmonary artery branch detected by three-dimensional computed tomography in a surgical case with apical lung cancer, a case report

et al. 2017

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“…However, the mediastinal basal artery is an extremely rare variation. Even rarer, as in our case, is when the mediastinal artery is composed not of the partial lingular and basal artery, but of the total lingular (A4 + 5) and basal artery (A8, A9, A10) [ 3 – 5 ]. Rare left pulmonary artery variations place patients at risk of fatal impact by provoking misguided vessel transection, especially in thoracoscopic surgery.…”

Section: Case Presentationmentioning

confidence: 62%

Composite resection of the left upper lobe and superior segment (S6) of the lower lobe for lung cancer with a mediastinal lingular and basal pulmonary artery

et al. 2018

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BackgroundPreoperative evaluation and awareness of anatomical variations in the pulmonary vessel is essential for a secure pulmonary resection. We herein present a patient who underwent complex pulmonary resection for lung cancer with a mediastinal lingular and basal pulmonary artery that had been detected by preoperative three-dimensional computed tomography.Case presentationThe patient was an asymptomatic 66-year-old woman who had a 39-pack-year smoking habit. Chest computed tomography (CT) revealed the tumor invading the left upper bronchus and pulmonary artery branches in the left upper lung lobe. Enhanced CT and three-dimensional (3D) images of the pulmonary artery revealed that pulmonary artery branches (A4 + 5, A8, and A9 + 10) were extending into the lingular and basal segment in ventral side of the left upper bronchus. We completed the resection by means of a composite resection of the left upper lobe and the superior segment of the lower lobe, avoiding pulmonary angioplasty to preserve the left lower lobe or pneumonectomy.Conclusions3D-CT is useful for detecting this rare variation of the left pulmonary artery before operation, allowing for proper resection.Electronic supplementary materialThe online version of this article (10.1186/s40792-018-0445-0) contains supplementary material, which is available to authorized users.

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“…Variations of the pulmonary artery are common on the left side, such as the mediastinal lingular pulmonary artery (Shibano et al 2011 ). For pulmonary veins, right-sided venous drainage shows more variations in number and pattern than the left side (Wannasopha et al 2012 ).…”

Section: Aorta and Pulmonary Vesselsmentioning

confidence: 99%

Pitfalls in Diagnostic Radiology

Peh¹

2015

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Dangerous mediastinal basal pulmonary artery during left upper lobectomy

Cited by 13 publications

References 4 publications

The first rib hypoplasia and the aberrant pulmonary artery branch detected by three-dimensional computed tomography in a surgical case with apical lung cancer, a case report

The first rib hypoplasia and the aberrant pulmonary artery branch detected by three-dimensional computed tomography in a surgical case with apical lung cancer, a case report

Composite resection of the left upper lobe and superior segment (S6) of the lower lobe for lung cancer with a mediastinal lingular and basal pulmonary artery

Pitfalls in Diagnostic Radiology

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