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Anomalous segmental vein for right upper lobe: an unusual anatomical variation

2002; Elsevier BV; Volume: 74; Issue: 1 Linguagem: Inglês

10.1016/s0003-4975(01)03164-2

1552-6259

Lorenzo Spaggiari, Piergiorgio Solli, Francesco Leo, Giulia Veronesi, Ugo Pastorino,

Central Venous Catheters and Hemodialysis

The pulmonary venous system may show several anomalies that must be well known during resection to avid perioperative bleeding mainly during video-assisted thoracoscopic surgery (VATS) procedures. Some of these anomalies are relatively frequent, whereas some others are exceptional. A 72-year-old man underwent right upper lobectomy for T2 N0 adenocarcinoma. During radical mediastinal dissection of R8 and 7 regional lymph nodes, an anomalous vascular structure arising from the left atrium, crossing behind the intermedius bronchus, and reaching the posterior segment was identified (Fig 1, operative view; Fig 2, schematic representation; A = azygous vein; B = bronchus for the right upper lobe; C = intermedius bronchus; D = left atrium; E = esophagus after lymph node dissection; F = anomalous segmental vein for the posterior segment of the right upper lobe.) After having isolated the veins for the right lobe and for the middle lobe, we identified the anomalous vein as the vein for the posterior segment of the right upper lobe, and it was safely divided.Fig 2View Large Image Figure ViewerDownload (PPT) Figure 3 is a preoperative computer tomographic thoracic scan showing the vascular anomaly behind the intermedius bronchus (arrows). This anomaly is exceptional; to the best of our knowledge, in the recent English-language literature, only a case report has been published [1Tsuboi M. Asamura H. Naruke T. Nakayama H. Kondo H. Tsuchiya R. A VATS lobectomy for lung cancer in a patient with an anomalous pulmonary vein report of a case.Surg Today. 1997; 27: 1074-1076Crossref PubMed Scopus (13) Google Scholar]. We believe that the knowledge of this anatomical variation is important especially when a VATS lobectomy has to be planned.