Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China.
Department of Imaging, West China Hospital Sichuan University, 37 Guoxuexiang Street, Wuhou District, Chengdu, 610041, China.
J Cardiothorac Surg. 2020 Sep 14;15(1):254. doi: 10.1186/s13019-020-01278-w.
With the popularization of thoracoscopic surgery, more and more macrovascular malformations have been reported. Understanding some vascular malformations with relatively fixed anatomical site and their range of drainage could avoid severe complications during the surgery. Persistent left superior vena cava (PLSVC) is a common thoracic vascular malformation, and is always combined with other cardiovascular dysplasia. As for the patient with upper left lung cancer in this case, he had PLSVC and left azygos vein, and non-metastatic enlargement of the lymph nodes at the same time, which had influenced the decisions on surgery and treatment. We made a summary of experience regarding this.
A 46-years-old male patient, his CT found a space-occupying lesion in the superior lobe of the left lung. The chest CT showed that the patient had PLSVC and left azygos vein, and multiple enlarged lymph nodes in the mediastinum. The patient received thoracoscopic upper left lung lobectomy and lymph node dissection. It was discovered that the left azygos vein had a concealed form, which influenced the lymph node dissection. The post-surgery pathology showed that there was squamous cell carcinoma in the upper left lung (pT2bN0M0 p Phase IIA) and no cancer metastasis with the lymph nodes. The patient had a good post-surgery recovery.
PLSVC is not rare, and is always combined with other vascular malformations. If discovering PLSVC before surgery, we suggest completing chest enhanced CT and vascular reconstruction, to find out other cardiovascular malformations that may exist. Left azygos vein is a rare vascular malformation, but it has a relatively fixed anatomical site, and always co-exists with PLSVC, therefore, understanding anatomy of left azygos vein is good for preventing accidental damage. Especially when performing surgery above the left pulmonary artery trunk, attention shall be paid to preventing damage to the left azygos vein. In addition, as for the patient with the diagnosis of lung cancer before surgery, it is not reliable to judge whether there is metastasis or not merely according to the size of the lymph nodes, instead, PET-CT or needle biopsy is recommended.
随着胸腔镜手术的普及，越来越多的大血管畸形被报道。了解一些具有相对固定解剖部位和引流范围的血管畸形，可以避免手术过程中出现严重并发症。永存左上腔静脉（PLSVC）是一种常见的胸血管畸形，常合并其他心血管发育不良。对于本例左上肺癌患者，存在 PLSVC 和左奇静脉，同时伴有非转移性淋巴结肿大，这影响了手术和治疗决策。我们对此进行了总结。
一名 46 岁男性患者，胸部 CT 发现左上肺占位性病变。胸部 CT 显示患者存在 PLSVC 和左奇静脉，纵隔内多个淋巴结肿大。患者接受了胸腔镜左上肺叶切除术和淋巴结清扫术。术中发现左奇静脉呈隐匿型，影响了淋巴结清扫。术后病理显示左上肺有鳞状细胞癌（pT2bN0M0 p Ⅱ A 期），无淋巴结转移。患者术后恢复良好。
PLSVC 并不罕见，常合并其他血管畸形。如果术前发现 PLSVC，建议完成胸部增强 CT 和血管重建，以发现可能存在的其他心血管畸形。左奇静脉是一种罕见的血管畸形，但它具有相对固定的解剖部位，常与 PLSVC 并存，因此了解左奇静脉的解剖结构有利于预防意外损伤。尤其是在左肺动脉干上方进行手术时，应注意防止左奇静脉损伤。此外，对于术前诊断为肺癌的患者，仅根据淋巴结大小判断是否存在转移不可靠，建议行 PET-CT 或针吸活检。
