Thoracoscopic right upper lobectomy in a patient with displaced posterior segmental bronchus and vascular abnormalities: a case report.

Background: Displaced posterior segmental bronchus (B²) accompanied by anomalous pulmonary vessels is a very rare condition. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer, especially thoracoscopic surgery.

Methods: We reported a case of thoracoscopic right upper lobectomy in a patient with a displaced B² and pulmonary vascular variation.

Results: A 74-year-old woman was admitted to our hospital with a 2.2 cm × 2.1 cm nodule in the right lung. Three-dimensional computed tomography (3D-CT) revealed the combined apical/anterior segmental branch (B^1 + 3) taken off the beginning of the right main bronchus (RMB), at the level of the carina. The displaced B² taken off the end of the RMB. The anomalous central vein (CV), which passed between B² and B^1 + 3, ran dorsal to the main pulmonary artery (MPA) and directly into the left atrium. The patient consequently underwent uniportal thoracoscopic right upper lobectomy and mediastinal lymph node dissection. The intraoperative findings were completely consistent with 3D-CT.

Conclusions: This paper reports a case of a displaced B² combined with right upper pulmonary vessels malformation. Under the guidance of 3D-CT, the right upper lobectomy was successfully completed by single hole thoracoscopic surgery.