Right Lower Lobectomy for Lung Cancer With a Right Top Pulmonary Vein

Figures

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  Figure 1. Patient 1: Imaging and surgical findings. A computed tomographic (CT) scan shows (A) a 2.5-cm radiologic pure solid lung tumor in the right lower lobe (RLL) and (B) a right top pulmonary vein (RTPV) passing behind the bronchus intermedius (arrow). (C) A 3-dimensional CT scan shows intersegmental veins of posterior segment (V2ab) flowing into the superior segmental vein (V6) as an RTPV. (D, E) Surgical findings show a right lower lobectomy and lower mediastinal nodal dissection with RTPV preservation. (A7-10, pulmonary artery; B6-10, bronchus; RUL, right upper lobe; V2a, V2b, V7-10, pulmonary veins.)

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  Figure 2. Patient 2: Imaging and surgical findings. A computed tomographic (CT) scan shows (A) a 1.7-cm radiologic part solid lung tumor in the right lower lobe (RLL) and (B) a right top pulmonary vein (RTPV) passing behind the bronchus intermedius (arrow). (C) A 3-dimensional CT scan shows intersegmental vein of posterior segment (V2b) flowing into the inferior pulmonary vein as an RTPV. (D, E) Surgical findings show a right lower lobectomy and lower mediastinal nodal dissection without RTPV preservation. The dotted circle indicates the 11s lymph node (LN). (A6-10, pulmonary artery; B1, B2+3, B4+5, B6-10, bronchi; RUL, right upper lobe; V6-10, pulmonary vein.)

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  Figure 3. Patient 1 vs patient 2: Surgical finding differences. Dotted circles indicate the 11s lymph node (LN). The dotted triangle indicates the part of the right lower lobe (RLL) lung parenchyma left behind on the right upper lobe (RUL) side. Dotted lines indicate the lower margins of the right and left main bronchi. (A2, A6, A8-10, A7, pulmonary arteries; Asc, ascending; B1-3, bronchus; V2a, V2b, V2ab, V6, V6-10, V7-10, pulmonary veins.)