Rare complex anatomical variation of right pulmonary vessels and bronchi: a case report

The patterns of bronchopulmonary vascular bifurcation within the lung exhibit considerable diversity. To perform safe and accurate anatomical pulmonary resections, an understanding of the anatomy of the pulmonary vessels and bronchi, including variations, is of utmost importance to general thoracic surgeons.

We performed a 3-dimensional (3D) computed tomography (CT) reconstruction of the pulmonary vessels and bronchi for a 66-year-old female patient. From the 3D reconstruction, we were able to observe clearly that this patient had complex variations in the right pulmonary artery, vein, and bronchus. Not only the bronchi and vessels of the right upper lobe, but also the vessels and bronchi of the middle and lower lobes are also variable. Due to this, we performed video-assisted right upper lobectomy and mediastinal lymph node dissection for her without misjudgment of the pulmonary vessels and bronchi. The patient recovered well and was discharged after 3 days.

We first report a very rare case involving complex variations in the right pulmonary artery, vein, and bronchus in a single patient using 3D reconstruction technology. We hope this article can remind all thoracic surgeons to evaluate the variations of pulmonary blood vessels and bronchi thoroughly and comprehensively before surgery and formulate appropriate surgical plans to ensure the successful implementation of the surgery.