A Pulmonary Vascular Variation to Be Considered in Resective Lung Surgical Procedures
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A Pulmonary Vascular Variation to Be Considered in Resective Lung Surgical Procedures Banu Yoldas, MD, and Soner Gursoy Izmir Dr. Suat Seren Chest Diseases and Thoracic Surgery, Training and Research Hospital, Izmir, Turkey P ulmonary variations and anomalies constitute one of the most important considerations during thoracic surgical procedures. Nowadays, videothoracoscopic resec- tion, which secures a better and more highly magnified visibility of thoracic structures because of the use of optical instruments, is more common. Nevertheless, such vascular anomalies may cause problems, especially during the learning curve. A 66-year-old man was evaluated for lung cancer, and a right upper lobectomy was planned. After hilar dissection, a pulmonary vein originating from the superior lobe of the lung and draining to the superior vena cava was detected (Fig 1). This vein was ligated, and resection continued. The truncus anterior of the upper lobe was located more distally than it should have been because of an abnormal venous vessel draining to the vena cava. Also, this segmental artery was not the usual width, and two similar arteries (including a posterior segmental artery) to the superior lobe were detected. One of these arteries was at the expected location of the middle lobe artery. A small posterior ascendan artery completed the arterial config- uration of the upper lobes. In addition to the abnormal vein draining to the vena cava, the upper lobe had an anterior segment vein draining to the left atrium. Moreover, the middle lobe vein was draining to the atrium with the inferior pulmo- nary vein (Fig 2). With careful exploration, an upper lo- bectomy was performed without any problems. After the operation, computed tomographic images were consid- ered retrospectively, and the accessory pulmonary vein was observed (Fig 3). Awareness of vascular anomalies and careful attention to all resection types is very important. Keeping such anatomic variations in mind may help young thoracic surgeons, especially, prevent potential morbidity and mortality. Fig 1. Fig 2. Fig 3. Address correspondence to Dr Yoldas, Izmir Dr. Suat Seren Chest Dis- eases and Thoracic Surgery, Training and Research Hospital, Izmir, Turkey; e-mail: [email protected]. Ó 2014 by The Society of Thoracic Surgeons Ann Thorac Surg 2014;97:715 0003-4975/$36.00 Published by Elsevier Inc http://dx.doi.org/10.1016/j.athoracsur.2013.06.065 FEATURE ARTICLES
Transcript of A Pulmonary Vascular Variation to Be Considered in Resective Lung Surgical Procedures
A Pulmonary Vascular Variation to Be Consideredin Resective Lung Surgical ProceduresBanu Yoldas, MD, and Soner GursoyIzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery, Training and Research Hospital, Izmir, Turkey
Fig 1.
Fig 3.
FEATUREARTIC
LES
ulmonary variations and anomalies constitute one
Fig 2.
Pof the most important considerations during thoracicsurgical procedures. Nowadays, videothoracoscopic resec-tion, which secures a better and more highly magnifiedvisibility of thoracic structures because of the use of opticalinstruments, is more common. Nevertheless, such vascularanomalies may cause problems, especially during thelearning curve.
A 66-year-old man was evaluated for lung cancer, and aright upper lobectomy was planned.
After hilar dissection, a pulmonary vein originatingfrom the superior lobe of the lung and draining to thesuperior vena cava was detected (Fig 1). This vein wasligated, and resection continued.
Address correspondence to Dr Yoldas, Izmir Dr. Suat Seren Chest Dis-eases and Thoracic Surgery, Training and Research Hospital, Izmir,Turkey; e-mail: [email protected].
� 2014 by The Society of Thoracic SurgeonsPublished by Elsevier Inc
The truncus anterior of the upper lobe was locatedmore distally than it should have been because of anabnormal venous vessel draining to the vena cava. Also,this segmental artery was not the usual width, and twosimilar arteries (including a posterior segmental artery) tothe superior lobe were detected. One of these arteries wasat the expected location of the middle lobe artery. A smallposterior ascendan artery completed the arterial config-uration of the upper lobes.In addition to the abnormal vein draining to the vena
cava, the upper lobe had an anterior segment veindraining to the left atrium. Moreover, the middle lobevein was draining to the atrium with the inferior pulmo-nary vein (Fig 2). With careful exploration, an upper lo-bectomy was performed without any problems. After theoperation, computed tomographic images were consid-ered retrospectively, and the accessory pulmonary veinwas observed (Fig 3).Awareness of vascular anomalies and careful attention to
all resection types is very important. Keeping suchanatomicvariations in mind may help young thoracic surgeons,especially, prevent potential morbidity and mortality.
Ann Thorac Surg 2014;97:715 � 0003-4975/$36.00http://dx.doi.org/10.1016/j.athoracsur.2013.06.065
