Tracheal bronchus combined with abnormal anatomical location of the pulmonary vein: A case report and literature review

Abstract

Abstract Background: Tracheal bronchus(TB）is originating from trachea or main bronchi and directed toward the upper lobe, most commonly it is about 2 cm or less from the carina. TB is a rare bronchial anomaly, the incidence of which has been reported in a range of 0.1% to 2%. It is more rare that TB combined with abnormal anatomical location of pulmonary veins. This paper reported an extremely rare case of TB combined with abnormal location of right superior lobar vein（RULV）. The right upper lobe was successfully removed and longitudinal lymph node dissection was performed. We also reviewed the relevant literature related to TB and the abnormal anatomical location of the right pulmonary vein. At present, there a few literature on this aspect on the world , so it is reported. Case presentation: The patient was a 71-year-old women who presented due to computed tomography(CT) results acquired at a local hospital. Preoperative CT of the chest indicated that the soft tissue of the upper lobe of the right lung was occupied. Three-dimensional CT of bronchus depicted TB from the right main bronchus. Intraoperative findings: the anatomical position of the RULV was variable, and it was located behind the right pulmonary artery(RPA). The postoperative pathological determination was right upper lung adenocarcinoma, and all the group of lymph nodes was nagative. The patient’s thoracic drainage tube was removed on the third postoperative day. Three weeks after the operation chest orthography indicated no obvious abnormality, and there has been no discomfort during follow-up. Conclusions : We report an extremely infrequent case of displaced TB combined with abnormal anatomical location of the right pulmonary vein to accentuate the importance of mastering normal chest anatomy and understanding possible anatomical abnormalities to ensure surgical safety. The surgeon should preoperative assessment of the anatomy carefully and required to identify an abnormal vascular or bronchial distribution, and thus safely complete a thoracic surgery. It is also hoped that additional similar cases will be described in the future.