Shigeeda Wataru, Tomoyasu Makoto, Yanagawa Naoki, Deguchi Hiroyuki, Kaneko Yuka, Yoshimura Ryuuichi, Kanno Hironaga, Sugai Mayu, Shikanai Shunsuke, Saito Hajime
Department of Thoracic Surgery, Iwate Medical University, 2-1-1, Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan.
Department of Molecular Diagnostic Pathology, Iwate Medical University, Iwate, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Mar 19;4(1):17. doi: 10.1186/s44215-025-00193-7.
The incidence rate of idiopathic dilatation of the pulmonary artery (IDPA) has been reported as 0.007%. We performed radical pulmonary resection under 3-port video-assisted thoracic surgery (VATS) in a patient with primary lung cancer and IDPA.
A 61-year-old man presented with an abnormality identified on chest X-ray during a medical check. Computed tomography revealed a 56-mm pulmonary tumor (diagnosed as squamous cell carcinoma by bronchoscopy) located in S of the right lower lobe, with clinical middle and lower interlobular lymph node metastasis on the basis of lymphadenopathy. Moreover, the right and left main pulmonary arteries were dilated, but the common basal artery after branches A, A, and A was normal. The presence of pulmonary hypertension was ruled out by cardiac catheterization, which revealed a pulmonary artery pressure within the normal range (24/11 mmHg). No infectious disease was present, and the patient did not have any history of chronic inflammatory disease. Therefore, IDPA was diagnosed. Surgery was performed, and the intraoperative findings were consistent with those of preoperative CT. Although there were concerns that the pulmonary artery wall might have been weakened due to IDPA, all pulmonary arteries, including the dilated right intermediate trunk, were cut safely with a stapler in this case.
In this case, the intraoperative and histopathological findings demonstrated no fragility of the pulmonary arteries, and the pulmonary artery was safely dissected using a stapler in 3-port VATS. However, radical surgery for lung cancer with IDPA is rare, and the safety needs to be verified by accumulating of further cases in the future.
据报道，特发性肺动脉扩张（IDPA）的发病率为0.007%。我们在一名原发性肺癌合并IDPA患者中，通过三端口电视辅助胸腔镜手术（VATS）进行了根治性肺切除术。
一名61岁男性在体检时胸部X线检查发现异常。计算机断层扫描显示右肺下叶S段有一个56毫米的肺部肿瘤（经支气管镜检查诊断为鳞状细胞癌），根据淋巴结肿大情况临床诊断为中、下叶间淋巴结转移。此外，左右主肺动脉扩张，但A、A和A分支后的共同基底动脉正常。心脏导管检查排除了肺动脉高压，显示肺动脉压力在正常范围内（24/11mmHg）。无传染病史，患者也没有任何慢性炎症性疾病史。因此，诊断为IDPA。进行了手术，术中发现与术前CT结果一致。尽管担心由于IDPA肺动脉壁可能已经变弱，但在本病例中，包括扩张的右中间干在内的所有肺动脉均用吻合器安全切断。
在本病例中，术中及组织病理学检查结果显示肺动脉无脆弱性，在三端口VATS中使用吻合器安全地解剖了肺动脉。然而，合并IDPA的肺癌根治性手术很少见，未来需要通过积累更多病例来验证其安全性。
