Thoracoscopic right apical segmentectomy in a patient with tracheal bronchus: a case report and review of literature.

A 70-year-old female patient was referred to our department for further abnormal chest shadow assessment in the right upper lung field. Computed tomography (CT) imaging detected multiple ground-glass nodules, resulting in primary lung cancer suspicion with no evidence of nodal involvement or distant metastasis. Three-dimensional CT revealed the presence of tracheal bronchus, directly branching off the right B1 bronchus from the trachea. Anomalous venous return was not observed. The patient was preoperatively diagnosed with cStage IA1 lung adenocarcinoma (cT1miN0M0) and underwent thoracoscopic S1 segmentectomy of the right upper lobe. Apical segmental bronchus was directly resected from the trachea, as expected based on preoperative CT examination. Pathologic diagnosis was pStage IA1 lung adenocarcinoma (pT1miN0M0). Multiple synchronous primary lung cancers were observed. The postoperative course was uneventful, and the patient demonstrated no recurrence at the 3-year postoperative follow-up. Tracheal bronchus is a rare abnormality observed in only 1% of patients undergoing thoracic surgery. Thoracic surgeons should be aware that preoperative planning based on three-dimensional CT is crucial in patients with tracheal bronchus because of potential issues associated with anomalous venous return. Good planning will contribute to safe segmentectomy in such cases.