A case of right middle lobectomy for primary lung cancer in a patient with heterotaxy syndrome.

Ryo Demura, Kazuhiro Imai, Shinogu Takashima, Nobuyasu Kurihara, Shoji Kuriyama, Haruka Suzuki, Yuzu Harata, Yoshihiro Minamiya
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Abstract

Background: Anatomical abnormalities in the pulmonary vessels have long aroused great interest among thoracic surgeons, and numerous variations of pulmonary vessels have been reported. Heterotaxy syndrome is an anatomical abnormality in which typically asymmetrical organs, including the lungs, develop symmetrically. We report the case of a 71-year-old man with heterotaxy syndrome undergoing radical lobectomy in the treatment of non-small cell lung cancer.

Case presentation: Computed tomography (CT) revealed an irregular nodule 25 mm in diameter in the right middle lobe. Two months later, at his first visit to our University Hospital, CT revealed a rapidly growing tumor 60 mm in diameter. In addition, three-dimensional (3D) CT revealed the upper and middle lobar bronchi forming a common trunk with the mediastinal type of the right pulmonary artery (PA). The patient underwent video-assisted right middle lobectomy + systematic complete hilar and mediastinal lymph node dissection. The interlobar fissure between the right upper and middle lobes was incomplete, and the common trunk formed by the upper-middle bronchus emerged from an area between the right PA (A1+3) and the right superior pulmonary vein.

Conclusion: The finding of A4+5 branching from the right main PA and descending posterior to the right upper-middle bronchus, which formed a common trunk, resembled a mirror image of the normal left lung. To our knowledge, a common trunk with the mediastinal type of the right PA has never been reported during video-assisted right middle lobectomy. In patients with heterotaxy syndrome, 3D-CT to preoperatively understand their anatomy is essential.

一例异位综合征患者因原发性肺癌接受右中叶切除术的病例。
背景:长期以来,肺血管的解剖异常一直引起胸外科医生的极大兴趣,已有大量关于肺血管变异的报道。异位综合征是一种解剖异常,包括肺在内的典型不对称器官会对称发育。我们报告了一例患有异位综合征的 71 岁男性病例,他在治疗非小细胞肺癌时接受了根治性肺叶切除术:计算机断层扫描(CT)显示,右肺中叶有一个直径 25 毫米的不规则结节。两个月后,在他第一次到我校医院就诊时,CT 显示肿瘤生长迅速,直径达 60 毫米。此外,三维(3D)CT 显示上叶和中叶支气管与右肺动脉(PA)纵隔型形成共同主干。患者接受了视频辅助下的右侧中叶切除术+系统性完全肺门和纵隔淋巴结清扫术。右上叶和中叶之间的叶间裂不完整,中上支气管形成的总干从右肺动脉(A1+3)和右上肺静脉之间的区域出现:结论:A4+5从右主PA分支,向右中上支气管后方下降,形成一条共同主干,这与正常左肺的镜像相似。据我们所知,在视频辅助右肺中叶切除术中,右 PA 纵隔型的共同主干从未被报道过。对于异位综合征患者,术前通过 3D-CT 了解其解剖结构至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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