ConclusionsĪ preoperative 3D CT may be helpful for identifying anatomical anomalies. The pathological diagnosis was a left lung abscess. Then there were accessory fissures between S 1+2 and S 3 and between S 6 and the basal segment. Intraoperative findings of the anatomy of the bronchi and pulmonary vessels were exactly the same as the preoperative 3D CT findings, so segmentectomy of S 1+2b+c and S 6 by VATS was performed safely. The branch of V 1+2 passed between B 6 and the bronchus to the basal segment and joined V 6 at the dorsal side of the pulmonary hilum. The branch of A 6 arose from the left main PA at the level of the branches of A 3 and A 1+2, more proximal than the normal anatomy, and passed to the dorsal side of a displaced B 1+2b+c. The three-dimensional (3D) CT with multiplanar reconstruction showed that B 1+2b+c passed to the dorsal side of the left main pulmonary artery (PA), which was considered a displaced bronchus. The chest computed tomography (CT) showed a multicystic mass with a diameter of 35 mm on dorsal interlobar parenchyma between the S 1+2 and S 6 segments in the left lung.

Case presentationĪ 48-year-old woman visited our hospital because of an abnormal shadow on a radiograph on a health check. 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.

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.

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