PMC5496814_01
Postnatal-enhanced computed tomography showing an anomalous arterial supply from the descending aorta to the left lower lobe.
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She was diagnosed antenatally with IPS in the left lung with anomalous arterial supply to the left basal segment ( Fig. 1 ).
Preoperative high-resolution computed tomography showing the affected BS with a normal AS. (
a
) UL, BS. (
b
) UL, AS. AS, apical segment; BS, basal segment; UL, upper lobe.
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The apical segment was hypertrophic, suggesting compensatory growth, with normal arterial perfusion, normal venous drainage, and a normal bronchial connection ( Fig. 2 ).
Intraoperative view. (
a
) AA and (
b
) UL, AS, BS, BA. AA, aberrant artery; AS, apical segment; BA, basal artery; BS, basal segment; UL, upper lobe.
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This was divided by silk thread ligation, clipping, and division using a bipolar system (the LigaSure vessel sealing system (Valleylab/Tyco Healthcare) ( Fig. 3a ). Fig. 3b ). Following confirmation of aeration in the apical segment, the basal bronchus was clamped and transected with an endoscopic linear stapler.
Thoracoscopic view after basal segmentectomy showing preserved healthy apical segment. AS, apical segment; UL, upper lobe.
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The lung parenchyma was divided with the stapler on the inflation-deflation line between the affected basal segment and the healthy apical segment ( Fig. 4 ).
Postoperative chest radiograph (
a
) 5 days after surgery and (
b
) 4 months after surgery.
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A chest radiograph 4 months postprocedure demonstrated satisfactory expansion of residual lung ( Fig. 5 ).