PMC9855748_01
CT imaging of the patient before the surgery. The red arrow refers to the oblique fissure, the yellow arrow refers to the S6 artery, and the blue arrow refers to the S6 bronchus, regarded by radiologists and surgeons.
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F1
The latest CT scan (10/2021) indicated a blade-like hyperdense shadow (2.4 cm x 2.0 cm) in the lower-left lung (Figure 1), which had a higher density than before (06/2019). CT and PET/CT reported that the nodule was located in the left dorsal segment (S6) (Figure 1). Considering the possibility of high suggestive malignancy, it was planned for this patient to receive a video-assisted thoracic surgery (VATS) lobectomy of the left lower lobe.
The three lobes of left lung photographed in the VATS. The yellow arrow refers to the lung nodule which cannot be found in the surface.
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F2
During intraoperative exploration, the patient was found to have a complete fissure splitting the upper lobe into two lobes (Figure 2).
(A) CT image before the surgery shows the three lobes of the left lung: 1, accessory lobe (S1 + 2); 2, the rest upper lobe; 3, lower lobe. (B) CT image before the surgery. The red arrow refers to true oblique fissure. The yellow arrow refers to the true S6 bronchus.
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F3
This misdiagnosis of location could be avoided, as the additional fissure, the real bronchus, and vessels of S1 + 2 and S6 were not tricky to identify in preoperative CT (Figure 3).