A rare anomaly of A4+5 on three-dimension multidetector computed tomography in lung cancer: A case report

INTRODUCTION: There are several anomalies of the pulmonary vessels. Clinicians need to be well informed about anatomy, particularly before video-assisted thoracic surgery, to prevent fatal complications. PRESENTATION OF CASE: We report the case of an 80-year-old woman who was suspected of having lung cancer in the right lower lobe. The patient was accordingly scheduled for surgery. Three-dimension multidetector computed tomography (3D-MDCT) showed an extremely rare anomaly in which A4 + 5 ran between V2 and V1 + 3. We scheduled a non-anatomical wedge resection of the lesion and performed rapid pathological diagnosis during surgery. Because adenocarcinoma was diagnosed, we performed right lower lobectomy using video-assisted thoracic surgery. Station 11i lymph node rigidly adhered to the main pulmonary artery, V2, and intermedius bronchus. Thus, the surgery was shifted to middle and lower lobectomy. DISCUSSION: To the best of our knowledge, this type of anomaly has not been reported yet. Pulmonary vessels can be accurately identified using 3D-MDCT; thus, a rare anatomy can be identified, and information can be shared across the surgical team simulating familiarity with this rare anatomy. CONCLUSION: Using 3D-MDCT, we could accurately divide A4 + 5 and safely perform the surgery.