Coexistent tracheal bronchus and azygos lobe: surgical planning and operative technique for robotic-assisted right upper lobectomy

Tracheal bronchus and azygos lobe are individually uncommon congenital anomalies arising from independent embryological mechanisms. Their simultaneous occurrence is exceptionally rare, with fewer than five cases identifiable in the published literature. We report an adult patient in whom a displaced apical segmental bronchus arising directly from the tracheal wall, a bifid right upper lobe bronchus comprising only the anterior and posterior segmental bronchi, and an associated azygos lobe. Elective robotic-assisted right upper lobectomy was undertaken for a biopsy proven primary lung cancer. Final histopathology confirmed grade 2 adenocarcinoma with clear surgical margins without lymph node involvement. Preoperative three-dimensional reconstruction was helpful for surgical planning and we describe the operative principles required to safely manage this unusual anatomical combination.