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Peer-reviewedCC BY-NC-ND 4.0Journal of Cardiothoracic Surgery

Thoracoscopic lobectomy for a mediastinal basal pulmonary artery: a case highlighting the importance of pulmonary arterial variations

  • Katsushi Toyohara1
  • Shohei Okai2
  • Sho Takeda2
  • Yuki Shindo2
  • Satoshi Fumimoto2
  • Kaoru Ochi2
  • Yoshio Ichihashi2
  • Kiyoshi Sato2
  • Nobuharu Hanaoka2
  • Takahiro Katsumata2
  1. 1Department of Thoracic Surgery, Hirakata Municipal Hospital, 2-14-1 Kinyahonmachi, 573-1013 Hirakata, Osaka, Japan
  2. 2Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686 Japan
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Abstract

Background: Mediastinal basal pulmonary artery (MPA) variations may increase the risk of unintentional vascular division or excessive bleeding during pulmonary resection. Therefore, precise preoperative anatomical assessment is particularly important.

Case presentation: We report a rare case of a MPA that was precisely identified preoperatively using three-dimensional computed tomography (3D-CT). Preoperative three-dimensional CT clearly demonstrated an independently branching mediastinal basal pulmonary artery. The patient underwent thoracoscopic left lower lobectomy for primary lung cancer. MPA branched independently from the main pulmonary artery, and division at the ventral interlobar level resulted in the formation of a relatively long arterial stump. The procedure was completed safely without unintentional vascular division, excessive bleeding, or postoperative thrombotic complications.

Conclusion: Previous reports have described interlobar division of anomalous pulmonary arteries in similar cases. However, the clinical benefit of additional proximal dissection solely to shorten the pulmonary artery stump remains unclear. Unnecessary dissection may increase the risk of bleeding. Careful preoperative anatomical assessment using 3D-CT enables safe surgical management. With expanding indications for segmentectomy, accurate recognition of pulmonary arterial variations will become increasingly important in clinical practice.

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Cite

BibTeXRIS
BibTeX
@article{toyohara2026thoracoscopic,
  title = {{Thoracoscopic lobectomy for a mediastinal basal pulmonary artery: a case highlighting the importance of pulmonary arterial variations}},
  author = {Katsushi Toyohara and Shohei Okai and Sho Takeda and Yuki Shindo and Satoshi Fumimoto and Kaoru Ochi and Yoshio Ichihashi and Kiyoshi Sato and Nobuharu Hanaoka and Takahiro Katsumata},
  journal = {Journal of Cardiothoracic Surgery},
  year = {2026},
  month = jul,
  doi = {10.1186/s13019-026-04517-8},
  url = {https://doi.org/10.1186/s13019-026-04517-8},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Thoracoscopic lobectomy for a mediastinal basal pulmonary artery: a case highlighting the importance of pulmonary arterial variations
AU  - Katsushi Toyohara
AU  - Shohei Okai
AU  - Sho Takeda
AU  - Yuki Shindo
AU  - Satoshi Fumimoto
AU  - Kaoru Ochi
AU  - Yoshio Ichihashi
AU  - Kiyoshi Sato
AU  - Nobuharu Hanaoka
AU  - Takahiro Katsumata
PY  - 2026
DA  - 2026/07/29
JO  - Journal of Cardiothoracic Surgery
DO  - 10.1186/s13019-026-04517-8
UR  - https://doi.org/10.1186/s13019-026-04517-8
AB  - Background: Mediastinal basal pulmonary artery (MPA) variations may increase the risk of unintentional vascular division or excessive bleeding during pulmonary resection. Therefore, precise preoperative anatomical assessment is particularly important.  Case presentation: We report a rare case of a MPA that was precisely identified preoperatively using three-dimensional computed tomography (3D-CT). Preoperative three-dimensional CT clearly demonstrated an independently branching mediastinal basal pulmonary artery. The patient underwent thoracoscopic left lower lobectomy for primary lung cancer. MPA branched independently from the main pulmonary artery, and division at the ventral interlobar level resulted in the formation of a relatively long arterial stump. The procedure was completed safely without unintentional vascular division, excessive bleeding, or postoperative thrombotic complications.  Conclusion: Previous reports have described interlobar division of anomalous pulmonary arteries in similar cases. However, the clinical benefit of additional proximal dissection solely to shorten the pulmonary artery stump remains unclear. Unnecessary dissection may increase the risk of bleeding. Careful preoperative anatomical assessment using 3D-CT enables safe surgical management. With expanding indications for segmentectomy, accurate recognition of pulmonary arterial variations will become increasingly important in clinical practice.
SN  - 1749-8090
ER  -