Anatomical variants of pulmonary segments and uni-portal thoracoscopic segmentectomy for lung cancer in a patient with Kartagener syndrome: a case report

Abstract

Situs inversus totalis (SIT) is an extremely uncommon congenital disease where the major organs of the body are transposed through the sagittal plane. Kartagener syndrome is a complication of SIT with immotility of bronchial cilia, bronchiectasis, and chronic sinusitis. There is no report describing patients with Kartagener syndrome who accept uni-portal segmentectomies for lung cancer in past studies. Here we report a 74-year-old female patient with both Kartagener syndrome and a small early-stage lung cancer lesion located in the apical segment of the left upper lobe (LS¹). The pulmonary segment anatomy of the left upper lobe in this case, which had very rare variants, was presented and interpreted in detail. This patient underwent an anatomic segmentectomy to the LS¹ and a partial excision to the left middle lobe with bronchiectasis through a single 3 cm length incision. We believe that the case can give surgeons some experience and inspiration.

Keywords: Anatomic segmentectomy; Kartagener syndrome; Lung cancer; Situs inversus totalis; VATS.

Fig. 1

The radiological findings of the pulmonary tumor and thoracic anatomy. a Situs inversus totalis (dextrocardia, aortic arch, stomach, and liver). b Chest CT revealed a pure ground-glass opacity (pGGO) (measuring 10 × 12 mm in diameter) located in LS¹. c Bronchiectasis with local inflammation was seen in the left middle lobe. d Bronchoscopy confirmed that the left and right bronchial branches were mirror-images of each other

Fig. 2

3D-CT images and designed surgical procedure. a left lung consisted of three lobes, the upper, middle, and lower lobes respectively. b The pGGO and the safe surgical margins were all completely within the LS¹. c Anatomical variation of the left upper lobe bronchi. d Anatomical variation of the left upper lobe pulmonary arteries. e Anatomical variation of the left upper lobe pulmonary veins. f Key points of variation in the anatomical structure of the left upper lobe

Fig. 3

The anatomic segmentectomy by uni-portal approach. a Only a single 3 cm incision for the surgery. b Azygos vein arch and superior vena cava were mirror images of a normal condition. The anterior mediastinal pleura is disassociated to expose the pulmonary artery and vein roots. c The target pulmonary arteries and veins were cut off. d intersegmental plane after the inflation-deflation technique. e Anatomy of segmental hilum after LS¹ resection