Abstract
Situs inversus totalis (SIT) is an extremely uncommon congenital disease where the major organs of the body are transposed through the sagittal plane. Kartagener syndrome is a complication of SIT with immotility of bronchial cilia, bronchiectasis, and chronic sinusitis. There is no report describing patients with Kartagener syndrome who accept uni-portal segmentectomies for lung cancer in past studies. Here we report a 74-year-old female patient with both Kartagener syndrome and a small early-stage lung cancer lesion located in the apical segment of the left upper lobe (LS1). The pulmonary segment anatomy of the left upper lobe in this case, which had very rare variants, was presented and interpreted in detail. This patient underwent an anatomic segmentectomy to the LS1 and a partial excision to the left middle lobe with bronchiectasis through a single 3 cm length incision. We believe that the case can give surgeons some experience and inspiration.
Highlights
Situs inversus totalis (SIT) is a rare congenital and autosomal recessive genetic disease which is connected with X-chromosome
In 20–25% of SIT cases, it coexists with Kartagener Syndrome [3]
Bronchoscopy confirmed that the left and right bronchial branches were mirror-images of each other (Fig. 1d). This patient had a preoperative diagnosis of pure ground-glass opacity (pGGO) in the left upper lobe and Kartagener Syndrome was proposed for L S1 segmentectomy and left middle lobe partial resection under uniportal video-assisted thoracoscopic surgery (VATS)
Summary
Situs inversus totalis (SIT) is a rare congenital and autosomal recessive genetic disease which is connected with X-chromosome. Bronchoscopy confirmed that the left and right bronchial branches were mirror-images of each other (Fig. 1d) This patient had a preoperative diagnosis of pGGO in the left upper lobe and Kartagener Syndrome was proposed for L S1 segmentectomy and left middle lobe partial resection under uniportal video-assisted thoracoscopic surgery (VATS). This artery was the third branch of the left main pulmonary artery, later than Asc.A3a We defined it as trunk bottom (Tr. Bot), which emanates from the pulmonary artery stem with the level of the upper lobe bottom and below the ascending artery, travels to the posterior and/or anterior segment. The mediastinal pleura was incised above the anterior hilum of the lung while the pulmonary artery and vein root of the left upper lobe was exposed (Fig. 3b). The chest tube was removed on the second postoperative day and the patient was discharged on the sixth postoperative day
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