Lobectomy for Right Lower Lobe Lung Cancer with Anomalous Systemic Arterial Supply and Partial Anomalous Pulmonary Venous Connection: A Case Report

Background: Anomalous systemic arterial supply to the basal lung (ASASB) and partial anomalous pulmonary venous connection (PAPVC) are rare congenital anomalies; their coexistence complicated by lung cancer has not been previously reported. Case presentation: A 68-year-old woman was referred for a right lower lobe mass detected on screening. Contrast-enhanced computed tomography showed an aberrant artery from the abdominal aorta supplying segments 9–10 and drainage of all right upper pulmonary veins into the superior vena cava. Qp/Qs on echocardiography was 1.3. Three-dimensional reconstruction clarified the vascular anatomy and guided thoracoscopic right lower lobectomy. The aberrant artery was doubly ligated at its intrathoracic origin and divided with a vascular stapler. Postoperative recovery was uneventful. Histology revealed papillary-predominant adenocarcinoma (pT2aN0M0). Twelve-month surveillance showed no recurrence or stump aneurysm; Qp/Qs decreased to 1.1. Conclusions: Careful cardiopulmonary evaluation and three-dimensional imaging permitted safe minimally invasive resection of lung cancer in the presence of simultaneous ASASB and PAPVC, and postoperative changes in Qp/Qs should be interpreted in the context of overall hemodynamic redistribution rather than as a simple arithmetic consequence of reduced systemic blood flow.