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INTRODUCTION

Dextrocardia, a condition characterized by the heart's anomalous positioning to the right, is frequently associated with venous abnormalities, but arterial anomalies are rare. In particular, systemic arterial supply to the posterior basal segment of a normal lung in dextrocardia is an exceedingly rare finding, with only one previously reported case.

CASE PRESENTATION

A 72-year-old female with a history of colorectal and gastric cancer surgeries presented with an abnormal chest X-ray showing a left lung shadow. She was asymptomatic, with no hemoptysis, cough, or dyspnea. Contrast-enhanced chest CT revealed dextrocardia and a thick anomalous artery branching from the aorta, running as the 9th intercostal artery, and supplying the S10 region of the left lung. Venous drainage was through a hypertrophic V10 branch of the pulmonary vein, with no evidence of sequestration or arteriovenous fistulas. Bronchoscopy excluded bronchial anomalies, confirming the diagnosis of anomalous systemic arterial supply to the posterior basal segment of a normal lung. Due to the patient's carotid arteriosclerosis and risk of fatal hemoptysis, video-assisted thoracoscopic surgery was performed. The anomalous artery was transected, and visibly engorged pleural regions were partially resected. The procedure was completed in 46 min with minimal blood loss. Histopathology showed normal lung tissue with vascular wall thickening. Follow-up imaging after 2 years revealed no vascular abnormalities, and the patient remains healthy 7 years postoperatively, with no aneurysmal changes at the surgical site.

CONCLUSIONS

We experienced a pulmonary artery originating from the aorta with perfusion only in a part of the basal segment of the lung complicated by a right thoracic heart. When preoperative angiography showed only segmental stain, it is considered safe and sufficient to resect only to the extent of the surface vasodilatation grossly during surgery.

INTRODUCTION

CASE PRESENTATION

CONCLUSIONS

引言

右位心是一种以心脏异常位于右侧为特征的病症，常与静脉异常相关，但动脉异常罕见。特别是，右位心中正常肺后基底段由体循环动脉供血是极其罕见的发现，此前仅有一例报道。

病例介绍

一名72岁女性，有结直肠癌和胃癌手术史，胸部X线检查异常显示左肺阴影。她无症状，无咯血、咳嗽或呼吸困难。胸部增强CT显示右位心以及一条粗大的异常动脉从主动脉分支，作为第9肋间动脉走行，并为左肺S10区域供血。静脉引流通过肺静脉的肥厚V10分支，无隔离或动静脉瘘的证据。支气管镜检查排除了支气管异常，确诊为正常肺后基底段的异常体循环动脉供血。由于患者有颈动脉粥样硬化及致命咯血风险，遂行电视辅助胸腔镜手术。切断异常动脉，并部分切除明显充血的胸膜区域。手术在46分钟内完成，失血极少。组织病理学显示肺组织正常，血管壁增厚。2年后的随访影像显示无血管异常，患者术后7年保持健康，手术部位无动脉瘤样改变。