気管支分岐異常・肺動脈走行異常を伴った転移性肺腫瘍の1例

Resection of Metastatic Lung Tumor with Abnormal Bronchial Bifurcation and Running Pulmonary Artery：Report of a Case

はじめに　気管支分岐異常の出現頻度は0.64％と報告されている．気管支分岐異常を認め，その異常気管支領域の区域切除術を行ったという報告はあまり多くない．右B1気管・気管支を伴う転移性肺腫瘍に対して胸腔鏡下右S1区域切除術を施行した症例を経験したため，文献的考察を加えて報告する．

The patient is a 69-year-old woman who underwent surgery for rectal cancer in January 202X. In July 202X＋2, computed tomography （CT） revealed a nodule shadow with a maximum diameter of 4 mm in S1 of the right lung. After three months, the nodule increased in size. Based on the patient’s history, a metastatic lung tumor was suspected, and the patient underwent surgical resection. Preoperative CT revealed the presence of B1 tracheobronchus and abnormal running of A1. B1 was more centrally located than usual and branched directly from the trachea, whereas A1 branched from the main pulmonary artery trunk. S1 segmentectomy was performed for suspected metastatic lung tumor nodule in S1. Abnormal running of the pulmonary artery poses a risk of vascular injury during surgery. In the case of abnormal bronchial branching, the pulmonary vessels may be abnormal, and it is important to recognize such abnormalities using contrast-enhanced or three-dimensional CT preoperatively.