Lung cancer with partial anomalous pulmonary venous connection in a different lobe: a case report

Autor: Hikaru Watanabe, Naoki Kanauchi, Soumei Matsuo, Kouhei Abe
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Lung Neoplasms
RD1-811
Case Report
Adenocarcinoma of Lung
Asymptomatic
Heart Septal Defects
Atrial
Systemic venous system
Anesthesiology
Internal medicine
medicine.artery
medicine
Humans
RD78.3-87.3
Heart Atria
Lung cancer
Carcinoma
Renal Cell
Aged
Heart Failure
Anomalous pulmonary venous connection
Lung
business.industry
Scimitar Syndrome
General Medicine
Thorax
medicine.disease
Kidney Neoplasms
Cardiac surgery
medicine.anatomical_structure
Pulmonary Veins
Cardiothoracic surgery
Pulmonary artery
Cardiology
Surgery
Neoplasm Recurrence
Local
medicine.symptom
Partial anomalous pulmonary venous connection • lung cancer • pulmonary to systemic flow ratio
Tomography
X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-4 (2021)
Journal of Cardiothoracic Surgery
ISSN: 1749-8090
Popis: Background Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure. Case presentation A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery. Conclusions We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.
Databáze: OpenAIRE
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