An Unusual Pulmonary Vascular Connection Encountered During Right Upper Lobectomy

Pulmonary vascular variations may complicate thoracic surgery, particularly video-assisted procedures, where such anomalies increase the risk of bleeding.

We report a 77-year-old female undergoing right upper lobectomy for invasive mucinous adenocarcinoma. Imaging revealed a 2 cm posterior right upper lobe nodule with low FDG uptake. Histology showed mixed adenocarcinoma and large-cell neuroendocrine carcinoma (stage IA). Intraoperatively, a vascular connection consistent with an arteriovenous fistula between the superior pulmonary vein and the interlobar pulmonary artery was identified and ligated.

Recognition of rare pulmonary vascular anomalies through careful preoperative imaging and intraoperative assessment is essential to minimize surgical complications and ensure safe thoracic resection..