Right sleeve S2 segmentectomy for lung carcinoid tumor in a patient with tracheal bronchus
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CASE REPORT
Right sleeve S2 segmentectomy for lung carcinoid tumor in a patient with tracheal bronchus Samuel Garcia‑Reina1 · Esther Fernandez1 · Isabel Nogueira2 · Pedro E. Lopez De Castro1 Received: 2 August 2020 / Accepted: 24 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Carcinoid tumors are relative rare neuroendocrine tumors of the lung. Bronchial obstruction’s symptoms as cough, hemoptysis and pneumonia may be present when they are centrally located and lung-sparing surgery is usually preferred. We describe the case of an adult patient with a central right upper lobe carcinoid tumor and a concurrent tracheal bronchus malformation. This peculiar bronchial malformation allowed a sleeve S2 segmentectomy sparing the S1–S3 segments and the middle and lower lobes. The patient was discharged on day 4 without complications. Keywords Sleeve lung resection · Bronchial malformation · Lung cancer
Introduction
Case report/description
Central tumors are the main indication for sleeve segmentectomy. This type of resection is more often left-sided and it is commonly described for S6 segmentectomy in both sides. Tracheal bronchus is a rare congenital anomaly that consists in an upper lobe or segmental bronchus arising from distal trachea. The origin of the bronchus is usually the lateral tracheal wall. Its incidence ranges from 0.1 to 2% [1] and it can be associated with another congenital anomalies (Down syndrome, esophageal anomalies, pulmonary hypoplasia and cardiac congenital defects).
A 32-year-old man with history of bronchial asthma is admitted in our institution presenting fever, cough and chest pain. A chest X-ray revealed a right lower lobe pneumoniae, so cephalosporin empiric antibiotic treatment was started. After 2 weeks of a slow clinical evolution, a flexible bronchoscopy was performed revealing a tracheal bronchus and an endobronchial lesion arising from right upper lobe bronchus, as shown in video (Online Resource 1, Fig. 1b). This lesion was originated in the external lateral wall of right upper bronchus presenting 90% airway obstruction of the main right bronchus. The bronchial biopsy confirmed the presence of typical carcinoid tumor. The patient did not present carcinoid syndrome. The contrast-enhanced computed tomography (CT) described the bronchial malformation and the presence of a 15 × 12 mm tumor (Fig. 1a); B1 and B3 arose together from right lateral tracheal wall and tracheal bronchus was less than 2 cm from carina. B2 arose from main right bronchus and was the origin of the tumor (Fig. 1c). The distance from the tumor to the origin of the middle lobe bronchus was 18.1 mm. There was an incomplete lobulation between the upper and lower lobe; however, top pulmonary vein was not present, as previously reported by Yaginuma [2]. Regard to lung vascularization, V2a + V2b drained into central vein and A2a + A2b branched from ascending artery. A1a + A1b and A 3a + A3b branched 1 1 from superior trunk and V a + V b and V3a + V3b drained into anterior vein (Fig.
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