Aberrant mediastinal basal pulmonary artery encountered at anatomical lung resection: A case report and review of the literature

TL;DR

A rare pulmonary artery variant was identified in a lung cancer patient using 3D imaging, preventing surgical complications.

Contribution

Demonstrates the effectiveness of 3D-CECT angiography in identifying a rare pulmonary artery variant before lung surgery.

Findings

3D-CECT angiography successfully identified a mediastinal basal pulmonary artery variant preoperatively.

Among 31 cases, the branching pattern of the artery was equally split between independent and common trunk types.

Mediastinal lingular artery was present in 71% of AP cases, higher than general reports.

Abstract

Abnormal branching of the pulmonary artery is often encountered in anatomical lung resection, which can potentially result in accidental vessel injury with life-threatening bleeding or extra lung resection. The mediastinal basal pulmonary artery (Arteria Praebronchialis, AP) is a very rare but potentially critical variant.

We present the case of a patient with lung cancer accompanied by the left basal segmental pulmonary artery, independent A8a+9, which was liable to be injured during lower lobectomy with poor interlobar fissure development. This variation was preoperatively recognized using three-dimensional contrast-enhanced computed tomography (3D-CECT) angiography, and vessel injury was avoided.

3D-CECT angiography was effective in identifying this rare but potentially critical variation, and it is desirable to perform it routinely before anatomical lung resection. A review of 31 AP cases revealed that the branching pattern of AP was independent (15 patients, 48 %) and common trunk type (16 patients, 52 %), one half for each. Mediastinal branching of the lingular artery was more frequent among the reported AP cases (71 %) than in general reports.

When mediastinal branches of left pulmonary artery are encountered, the possibility that it is AP should be always taken into account.

•A lung cancer patient with AP, A8a+9, underwent safe thoracoscopic left lower lobectomy.•3D-CECT angiography is effective in identifying this rare but potentially critical variation.•Branching pattern of 31 AP cases comprised independent and common trunk types, with one-half each.•AP cases were more frequently accompanied by a mediastinal lingular artery (71 %) than generally reported.

A lung cancer patient with AP, A8a+9, underwent safe thoracoscopic left lower lobectomy.

3D-CECT angiography is effective in identifying this rare but potentially critical variation.

Branching pattern of 31 AP cases comprised independent and common trunk types, with one-half each.

AP cases were more frequently accompanied by a mediastinal lingular artery (71 %) than generally reported.

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