Our Summary

The case study is about a 78-year-old man who was being treated for diabetes and was found to have an unusual shadow in his left lung via a chest X-ray. Further tests using a CT scan showed a tumor in the upper left lobe of his lung and a cyst in the lower left lobe. They also found two unusual arteries coming from the aorta near the cyst. He was diagnosed with lung cancer and a rare condition where the lower part of the lung is supplied blood from an unusual source (ABLL).

He needed surgery to treat these conditions. The surgical team used a method called thoracoscopic surgery, which is a minimally invasive surgery that uses a special camera. They also used a dye called Indocyanine green (ICG) to help them identify the exact area to be operated on. They were able to remove the two unusual arteries and the area of the lung supplied by these arteries by using the dye multiple times.

This case shows that using ICG multiple times can help not only in precisely removing part of the lung (upper segmentectomy) but also in accurately identifying and removing the parts of the lung supplied by unusual arteries.

FAQs

  1. What is an anomalous systemic arterial supply to the basal segment of the lung (ABLL)?
  2. How is Indocyanine green (ICG) used in thoracoscopic surgery for lung cancer treatment?
  3. What is the purpose of resecting the aberrant arteries and the perfusion area they supply in lung cancer surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung resection is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding smoking or exposure to secondhand smoke to promote optimal healing and reduce the risk of complications. It is also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support lung health and overall well-being.

Suitable For

Patients who are typically recommended lung resection include those with lung cancer, especially in cases where the tumor is localized and can be surgically removed. Other conditions that may warrant lung resection include lung infections, such as tuberculosis or fungal infections, as well as certain benign lung tumors or cysts. Patients with severe emphysema or chronic obstructive pulmonary disease (COPD) may also be candidates for lung volume reduction surgery or lung transplantation. Additionally, patients with abnormal vascular anatomy, such as anomalous systemic arterial supply to the lung, may require lung resection to address the vascular anomaly and associated health risks.

Timeline

  • Patient undergoes chest X-ray due to diabetes treatment
  • Abnormal shadow in left upper lung field detected
  • Chest contrast-enhanced CT reveals tumor in left upper lobe and cystic lesion in left lower lobe
  • Aberrant arteries branching from aorta identified near cyst
  • Patient diagnosed with lung cancer and anomalous systemic arterial supply to basal segment of left lung
  • Thoracoscopic surgery performed, guided by Indocyanine green for precise intersegmental plane identification
  • Aberrant arteries resected, perfusion area supplied by arteries excised using repeated ICG intravenous injection
  • Precise upper segmentectomy and accurate visualization and resection of perfusion area achieved
  • Overall successful treatment and recovery for patient

What to Ask Your Doctor

  1. What are the risks and benefits of lung resection surgery in my specific case?
  2. How will the surgery impact my lung function and overall health?
  3. What is the expected recovery time and what can I do to aid in my recovery?
  4. Will I need any additional treatments or follow-up care after the surgery?
  5. How will the presence of anomalous systemic arterial supply to the lung impact the surgical procedure?
  6. How will Indocyanine green be used during the surgery and what are the potential benefits of this technique?
  7. What is the likelihood of the lung cancer returning after surgery?
  8. Are there any alternative treatment options available for my condition?
  9. How many similar surgeries have you performed and what is your success rate?
  10. What lifestyle changes, if any, should I make after the surgery to improve my long-term health outcomes?

Reference

Authors: Shinohara S, Yasuda M, Take N, Chikaishi Y, Tsuruno K, Tobino K. Journal: J UOEH. 2024;46(4):293-297. doi: 10.7888/juoeh.46.293. PMID: 39617489