Lobectomy for lung cancer with a displaced left B(1 + 2) and an anomalous pulmonary vein: a case report

BACKGROUND: A displaced left B(1 + 2) accompanied by an anomalous pulmonary vein is a rare condition involving complex structures. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer. CASE PRESENTATION: A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B(1 + 2) and hyperlobulation between S(1 + 2) and S(3), while the interlobar fissure between S(1 + 2) and S(6) was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V(1 + 2) joining the left inferior pulmonary vein and a branch of the V(1 + 2) running between S(1 + 2) and S(6). We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V(1 + 2) and confirm the locations of B(1 + 2) and B(6) when dividing the fissure. CONCLUSION: The aim of the surgical procedure performed in this case was to divide the fissure between S(1 + 2) and the inferior lobe to reduce the risk of an unexpected bronchial injury. 3D-CT helps surgeons to understand the stereoscopic positional relationships among anatomical structures.