Tateno Yukino, Yazawa Tomohiro, Nagashima Toshiteru, Ohtaki Yoichi, Kawatani Natsuko, Yoshikawa Ryohei, Narusawa Eiji, Shirabe Ken
Department of Surgery, Fujioka General Hospital, Fujioka, Japan.
Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma 371-8511 Japan.
Int Cancer Conf J. 2025 Jan 20;14(2):119-123. doi: 10.1007/s13691-025-00746-1. eCollection 2025 Apr.
A 70-year-old female patient was referred to our department for further abnormal chest shadow assessment in the right upper lung field. Computed tomography (CT) imaging detected multiple ground-glass nodules, resulting in primary lung cancer suspicion with no evidence of nodal involvement or distant metastasis. Three-dimensional CT revealed the presence of tracheal bronchus, directly branching off the right B1 bronchus from the trachea. Anomalous venous return was not observed. The patient was preoperatively diagnosed with cStage IA1 lung adenocarcinoma (cT1miN0M0) and underwent thoracoscopic S1 segmentectomy of the right upper lobe. Apical segmental bronchus was directly resected from the trachea, as expected based on preoperative CT examination. Pathologic diagnosis was pStage IA1 lung adenocarcinoma (pT1miN0M0). Multiple synchronous primary lung cancers were observed. The postoperative course was uneventful, and the patient demonstrated no recurrence at the 3-year postoperative follow-up. Tracheal bronchus is a rare abnormality observed in only 1% of patients undergoing thoracic surgery. Thoracic surgeons should be aware that preoperative planning based on three-dimensional CT is crucial in patients with tracheal bronchus because of potential issues associated with anomalous venous return. Good planning will contribute to safe segmentectomy in such cases.
一名70岁女性患者因右上肺野异常胸部阴影被转诊至我科进一步评估。计算机断层扫描（CT）成像检测到多个磨玻璃结节，怀疑为原发性肺癌，无淋巴结受累或远处转移证据。三维CT显示存在气管支气管，直接从气管分支至右B1支气管。未观察到异常静脉回流。患者术前诊断为cStage IA1肺腺癌（cT1miN0M0），并接受了右上叶胸腔镜S1段切除术。如术前CT检查所预期，尖段支气管直接从气管切除。病理诊断为pStage IA1肺腺癌（pT1miN0M0）。观察到多个同步原发性肺癌。术后过程顺利，患者在术后3年随访中未出现复发。气管支气管是一种罕见的异常，仅在1%的胸外科手术患者中观察到。胸外科医生应意识到，由于与异常静脉回流相关的潜在问题，基于三维CT的术前规划对于气管支气管患者至关重要。良好的规划将有助于此类病例的安全段切除术。
