Abstract
BackgroundA displaced bronchus is a rare disorder of the left upper lobe. Displaced bronchi are often accompanied by an anomaly of a pulmonary artery, but rarely of a pulmonary vein.Case presentationWe here present a patient with primary lung cancer and simultaneous migration abnormalities of the pulmonary artery and vein in a displaced bronchus of the left upper lobe. Previous reports and our findings indicate that anomalies of the pulmonary artery and vein combined with a displaced bronchus of the left upper lobe have the following characteristics: (1) the left main pulmonary artery does not cross the dorsal side of the displaced bronchus; (2) V1 + 2 returns to the inferior pulmonary vein; and (3) there is an accessory fissure (aberrant fissure) in the segments dominated by the displaced bronchus.ConclusionsPrevention of intraoperative damage during procedures for a displaced bronchus and pulmonary arteriovenous anomalies requires careful preoperative evaluation and surgical technique with particular attention to the above-listed characteristics.
Highlights
A displaced bronchus is a rare disorder of the left upper lobe
We here report performing a segmentectomy for a left upper lobe lung cancer in a patient with a displaced bronchus in whom the left main pulmonary artery and superior pulmonary vein both took abnormal courses
Three-dimensional reconstructed images of the pulmonary artery and vein had been prepared preoperatively, whereas images that included the bronchi were only prepared postoperatively. The latter showed the following: B1 + 2 + B3 was branching from the left main bronchus, followed by a bronchus that corresponded to the middle bronchial trunk of the right lung, and B4 + 5 and the lower lobe bronchus (Fig. 3a, b); the left main pulmonary artery was on the ventral side of B1 + 2 + B3 and did not cross the dorsal side of the left main bronchus; and
Summary
When the bronchi and pulmonary artery and veins all take abnormal courses in the left lung, the following is usually present. (1) The left main pulmonary artery does not cross the dorsal side of the displaced bronchus. (2) V1 + 2 returns to the inferior pulmonary vein. (3) There is an accessory fissure in the segments dominated by the displaced bronchus. When the bronchi and pulmonary artery and veins all take abnormal courses in the left lung, the following is usually present. (1) The left main pulmonary artery does not cross the dorsal side of the displaced bronchus. (2) V1 + 2 returns to the inferior pulmonary vein. (3) There is an accessory fissure in the segments dominated by the displaced bronchus. Surgeons need to be aware of these features to prevent damage during surgery. Focusing on any accessory fissure when performing preoperative evaluations may maximize detection of associated anomalies
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