Confirmation of a variant lingular vein anatomy during thoracoscopic surgery

Variations in pulmonary veins can have a serious effect on patients undergoing lung surgery. But few clinicians are familiar with patients who have these variations, and few have been reported in the left pulmonary vein. We report the case of a lung cancer patient with a variant anatomy in the inferior segment of the lingular vein (V5) that drained into the left inferior pulmonary vein. A preoperative review of the patient's three-dimensional 64-row multidetector computed tomography (3D MDCT) imaging showed that the variant vein (V5) was draining from the inferior lingular segment into the upper side of the inferior pulmonary vein, which was also observed on conventional CT films. This variant anatomy was confirmed during a thoracoscopic left upper lobectomy. Furthermore, the superior segment (V6) of the inferior pulmonary vein drained into the basal part of the inferior pulmonary vein, but not into the superior side where V5 in this patient was drained. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. Preoperative 3D MDCT imaging of the pulmonary vein allowed good visualization of the patient's vascular variant during surgery, and it contributed to safe thoracic surgery, especially in a thoracoscopic operation.