Abstract
BACKGROUND: Tracheobronchial anomalies are extremely rare and are often associated with pulmonary arteriovenous anatomical anomalies. An anomalous right upper vein segment that passes between the pulmonary artery (PA) and bronchus is a rare vascular abnormality. We report a case of a displaced superior posterior branch (B2) that was independent of the superior apical/anterior branch (B1 + 3) accompanied by anomalous right superior pulmonary vein (SPV) anatomy in a patient who underwent right upper lobectomy for lung cancer with lymph node metastases. CASE PRESENTATION: A 73-year-old asymptomatic woman was shown to have an abnormal shadow on chest radiography performed during medical checkup and visited our hospital for further evaluation. The patient was diagnosed with primary lung adenocarcinoma (c-T1cN1M0, stage IIB) involving the right superior posterior segment (S2) with an abnormally displaced B2 and an anomalous upper vein segment that was observed to run dorsal to the PA and anterior to the right upper bronchus. We performed right upper lobectomy and systematic hilar and mediastinal nodal dissection via video-assisted thoracoscopic surgery. Intraoperative findings revealed a displaced B2 bronchus independent from the B1 + 3 and an anomalous SPV, which was consistent with preoperative imaging findings. CONCLUSION: Preoperative bronchoscopy and three-dimensional computed tomography angiography (3D-CTA) are essential to confirm bronchial bifurcation and vascular abnormalities to aid with meticulous surgical planning to select the optimal operative technique.