A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report
Abstract Background Since a displaced bronchus related to the left upper lobe is an uncommon anatomical anomaly, it has a risk of being accidentally resected during left upper lobe resection unless they are identified preoperatively. A case of video-assisted thoracic surgery (VATS) segmentectomy tha...
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doaj-942bdd60988a44d8993cafe4faf0a1992020-11-25T03:54:56ZengSpringerOpenSurgical Case Reports2198-77932019-04-01511610.1186/s40792-019-0627-4A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case reportKazuto Ohtaka0Nozomu Iwashiro1Kazunori Watanabe2Tomoko Mizota3Ryo Takahashi4Masato Suzuoki5Kazuteru Komuro6Masanori Ohara7Kichizo Kaga8Yoshiro Matsui9Department of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Surgery, National Hospital Organization Hakodate National HospitalDepartment of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of MedicineDepartment of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of MedicineAbstract Background Since a displaced bronchus related to the left upper lobe is an uncommon anatomical anomaly, it has a risk of being accidentally resected during left upper lobe resection unless they are identified preoperatively. A case of video-assisted thoracic surgery (VATS) segmentectomy that was safely performed under preoperative identification of a displaced subsegmental bronchus and anomalous pulmonary vessels is presented. Case presentation A 48-year-old woman visited our hospital because of an abnormal shadow on a radiograph on a health check. The chest computed tomography (CT) showed a multicystic mass with a diameter of 35 mm on dorsal interlobar parenchyma between the S1+2 and S6 segments in the left lung. The three-dimensional (3D) CT with multiplanar reconstruction showed that B1+2b+c passed to the dorsal side of the left main pulmonary artery (PA), which was considered a displaced bronchus. The branch of A6 arose from the left main PA at the level of the branches of A3 and A1+2, more proximal than the normal anatomy, and passed to the dorsal side of a displaced B1+2b+c. The branch of V1+2 passed between B6 and the bronchus to the basal segment and joined V6 at the dorsal side of the pulmonary hilum. Intraoperative findings of the anatomy of the bronchi and pulmonary vessels were exactly the same as the preoperative 3D CT findings, so segmentectomy of S1+2b+c and S6 by VATS was performed safely. Then there were accessory fissures between S1+2 and S3 and between S6 and the basal segment. The pathological diagnosis was a left lung abscess. Conclusions A preoperative 3D CT may be helpful for identifying anatomical anomalies. An anatomical anomaly should be suspected if accessory fissure is found during surgery.http://link.springer.com/article/10.1186/s40792-019-0627-4Displaced bronchusEparterial bronchusPulmonary arteryPulmonary veinAccessory fissureAnomaly |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kazuto Ohtaka Nozomu Iwashiro Kazunori Watanabe Tomoko Mizota Ryo Takahashi Masato Suzuoki Kazuteru Komuro Masanori Ohara Kichizo Kaga Yoshiro Matsui |
spellingShingle |
Kazuto Ohtaka Nozomu Iwashiro Kazunori Watanabe Tomoko Mizota Ryo Takahashi Masato Suzuoki Kazuteru Komuro Masanori Ohara Kichizo Kaga Yoshiro Matsui A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report Surgical Case Reports Displaced bronchus Eparterial bronchus Pulmonary artery Pulmonary vein Accessory fissure Anomaly |
author_facet |
Kazuto Ohtaka Nozomu Iwashiro Kazunori Watanabe Tomoko Mizota Ryo Takahashi Masato Suzuoki Kazuteru Komuro Masanori Ohara Kichizo Kaga Yoshiro Matsui |
author_sort |
Kazuto Ohtaka |
title |
A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
title_short |
A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
title_full |
A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
title_fullStr |
A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
title_full_unstemmed |
A left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
title_sort |
left lung abscess with a displaced subsegmental bronchus and anomalous pulmonary artery and vein: a case report |
publisher |
SpringerOpen |
series |
Surgical Case Reports |
issn |
2198-7793 |
publishDate |
2019-04-01 |
description |
Abstract Background Since a displaced bronchus related to the left upper lobe is an uncommon anatomical anomaly, it has a risk of being accidentally resected during left upper lobe resection unless they are identified preoperatively. A case of video-assisted thoracic surgery (VATS) segmentectomy that was safely performed under preoperative identification of a displaced subsegmental bronchus and anomalous pulmonary vessels is presented. Case presentation A 48-year-old woman visited our hospital because of an abnormal shadow on a radiograph on a health check. The chest computed tomography (CT) showed a multicystic mass with a diameter of 35 mm on dorsal interlobar parenchyma between the S1+2 and S6 segments in the left lung. The three-dimensional (3D) CT with multiplanar reconstruction showed that B1+2b+c passed to the dorsal side of the left main pulmonary artery (PA), which was considered a displaced bronchus. The branch of A6 arose from the left main PA at the level of the branches of A3 and A1+2, more proximal than the normal anatomy, and passed to the dorsal side of a displaced B1+2b+c. The branch of V1+2 passed between B6 and the bronchus to the basal segment and joined V6 at the dorsal side of the pulmonary hilum. Intraoperative findings of the anatomy of the bronchi and pulmonary vessels were exactly the same as the preoperative 3D CT findings, so segmentectomy of S1+2b+c and S6 by VATS was performed safely. Then there were accessory fissures between S1+2 and S3 and between S6 and the basal segment. The pathological diagnosis was a left lung abscess. Conclusions A preoperative 3D CT may be helpful for identifying anatomical anomalies. An anatomical anomaly should be suspected if accessory fissure is found during surgery. |
topic |
Displaced bronchus Eparterial bronchus Pulmonary artery Pulmonary vein Accessory fissure Anomaly |
url |
http://link.springer.com/article/10.1186/s40792-019-0627-4 |
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