Asakura Keisuke, Izumi Yotaro, Kohno Mitsutomo, Watanabe Masazumi, Arai Takahide, Nomori Hiroaki
Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2014;20 Suppl:457-60. doi: 10.5761/atcs.cr.12.01975. Epub 2013 Jan 31.
A 64-year-old man with primary lung cancer (cT1aN0M0) was diagnosed as having partial anomalous pulmonary venous connection (PAPVC) in the same lobe by preoperative chest computed tomography (CT). The anomalous vein originated from left upper lobe pulmonary vein and flowed into the left brachiocephalic vein. Although the patient was asymptomatic, cardiac catheterization revealed that pulmonary-systemic blood flow ratio (Qp/Qs ratio) was 2.0, and his pulmonary arterial pressure was marginally elevated (60/18 mmHg). We performed left upper lobectomy as the definitive treatment for both lung cancer and PAPVC. His pulmonary arterial pressure decreased after lobectomy (33/16 mmHg). He is living well without relapse of lung cancer 56 months after surgery. Although PAPVC is detectable on computed tomography, out of 7 previous reports of PAPVC associated with lung cancer, only 2 cases were diagnosed preoperatively. The presence of PAPVC should be kept in mind before major lung resections.
一名64岁的原发性肺癌(cT1aN0M0)男性患者,术前胸部计算机断层扫描(CT)诊断为同一肺叶存在部分性肺静脉异位连接(PAPVC)。异常静脉起源于左上肺静脉,流入左头臂静脉。尽管患者无症状,但心导管检查显示肺循环与体循环血流量比值(Qp/Qs比值)为2.0,肺动脉压略有升高(60/18 mmHg)。我们实施了左上肺叶切除术,作为肺癌和PAPVC的确定性治疗方法。肺叶切除术后他的肺动脉压下降(33/16 mmHg)。术后56个月,他生活良好,肺癌未复发。尽管PAPVC在计算机断层扫描中可被检测到,但在之前7例与肺癌相关的PAPVC报告中,只有2例术前被诊断出来。在进行大型肺切除术前应考虑到PAPVC的存在。