case_images: PMC11334133_01
case_images: Imaging findings in Case 1. (a) Initial chest computed tomography showing a tumor with lymph node involvement, extensively connected to the right upper-lobe branch. (b) Preoperative hilar vascular 3D image showing compression of A1+A3 and A2 by the tumor with preserved peripheral blood flow.
case_images: 10.1177_2050313X241275025-fig1.jpg
case_images: PMC11334133_01_10.1177_2050313X241275025-fig1.jpg
case_images: fig1-2050313X241275025
case_images: The tumor that had invaded neighboring lymph nodes (10 and 11 s), was extensively connected to the bronchus of the right upper lobe, necessitating bronchoplasty (Figure 1(a)). Contrast-enhanced computed tomography with 3D reconstruction showed compression of A1+3 and A2 by the tumor (Figure 1(b)).
case_images: PMC11334133_02
case_images: Imaging findings in Case 2. (a) Initial chest computed tomography showing a part-solid nodule in the right upper lobe. (b) Preoperative hilar vascular 3D image (posterior view) showing branching of A1+recurrent A2 centrally from the SVC.. SVC: superior vena cava.
case_images: 10.1177_2050313X241275025-fig2.jpg
case_images: PMC11334133_02_10.1177_2050313X241275025-fig2.jpg
case_images: fig2-2050313X241275025
case_images: A 56-year-old man had suspected right upper-lobe lung cancer (cT1aN0M0 stage IA1) based on screening chest radiography and computed tomography (Figure 2(a)). However, the bifurcation of A1+recurrent A2 was proximal to the right main pulmonary artery trunk (Figure 2(b)), making it difficult to isolate and encircle the proximal region of the A1+recurrent A2 when the bleeding area was compressed.
case_images: Intraoperative findings in Case 2.. ((a) and (b)) After dividing A3, an accidental injury occurred to the periphery of A1+recurrent A2 during dissection, resulting in bleeding.. (c) The procedure was modified to a thoracotomy; however, it was impossible to encircle the proximal A1+recurrent A2. Therefore, a strategy was adopted to circle the right main PA between the SVC and the ascending aorta. The angle of forceps insertion was too acute concerning the right main PA, hindering smooth encircling. Consequently, the thoracotomy incision was extended anteriorly to ensure a safe and clear path for the forceps toward the right main PA. Once the right main PA was clamped, A1+recurrent A2 was divided (red tape, phrenic nerve).. SVC: superior vena cava; PA: pulmonary artery.
case_images: 10.1177_2050313X241275025-fig3.jpg
case_images: PMC11334133_02_10.1177_2050313X241275025-fig3.jpg
case_images: fig3-2050313X241275025
case_images: Following the dissection of A3, accidental bleeding was noted while dividing A1+recurrent A2, necessitating thoracotomy (Figure 3(a) and (b)). The thoracotomy was extended anteriorly to the level of the right internal thoracic artery, and the right main pulmonary artery was encircled between the SVC and ascending aorta (Figure 3(c)).