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右上肺静脉罕见异常:一例报告。

A rare anomaly of the right superior pulmonary vein: Report of a case.

作者信息

Ichiki Yoshinobu, Kakizoe Kesei, Hamatsu Takayuki, Suehiro Taketoshi, Koike Makiko, Tanaka Fumihiro, Sugimachi Keizo

机构信息

Department of Chest Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan.

Department of Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan.

出版信息

Int J Surg Case Rep. 2017;38:26-28. doi: 10.1016/j.ijscr.2017.05.035. Epub 2017 Jul 6.

Abstract

INTRODUCTION

Although there are a lot of variations of pulmonary veins (PVs) including dangerous type that could cause serous complications during the surgery, limited information has been reported about these variations. We have experienced an extremely rare anomaly of the right superior PV.

PRESENTATION OF CASE

A 74-year-old man patient with right lung cancer visited our hospital. Chest computed tomography (CT) revealed a pulmonary nodule in the right lower lobe. Contrast-enhanced three-dimensional CT (3D-CT) showed that the right superior PV ran abnormally between the right main pulmonary artery (PA) and the right main bronchus. We performed right lower lobectomy and systematic nodal dissection. The operative findings confirmed that the right superior PV ran abnormally same as 3D-CT.

DISCUSSION

In most reported cases, anomalous PVs pass behind the right bronchi or into the roof of the left atrium. The anomaly reported in the present case has been reported in only one case report. This case suggests that the space between the right main PA and the right main bronchus is not always safe for dissection.

CONCLUSION

Preoperative 3D-CT is useful for avoiding unexpected bleeding.

摘要

引言

尽管肺静脉(PVs)存在多种变异,包括在手术过程中可能导致严重并发症的危险类型,但关于这些变异的报道信息有限。我们遇到了一例极其罕见的右上肺静脉异常病例。

病例介绍

一名74岁男性肺癌患者前来我院就诊。胸部计算机断层扫描(CT)显示右下叶有一个肺结节。增强三维CT(3D-CT)显示右上肺静脉在右主肺动脉(PA)和右主支气管之间异常走行。我们进行了右下叶切除术和系统性淋巴结清扫术。手术结果证实右上肺静脉走行异常,与3D-CT显示一致。

讨论

在大多数报道的病例中,异常肺静脉走行于右支气管后方或进入左心房顶部。本病例报道的这种异常仅在一篇病例报告中出现过。该病例表明,右主肺动脉和右主支气管之间的间隙并不总是安全的手术分离区域。

结论

术前3D-CT有助于避免意外出血。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6df0/5517782/961450b3833e/gr1.jpg

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