A rare anomaly of A4+5 on three-dimension computed tomograph
In lung surgery, there are several variations in the pulmonary vessels. Anomalies of the pulmonary vessels can cause serious complications, such as bleeding. It is important to understand the correct anatomy to safely perform surgery, especially in case of video-assisted thoracic surgery (VATS).

In an 80-year-old woman, an abnormal shadow was detected in the right lung field during a routine physical examination.

Chest computed tomography (CT) revealed a 15-mm tumor in the right lower lobe that slowly increased in size. Laboratory examination showed an increase in carcinoembryonic antigen level at 9.2 ng/mL. Bronchoscopy was performed; however, no signs of malignancy and abnormalities in the branching pattern of the bronchial trees were observed. Further, 18F-fluorodeoxyglocose positron emission tomography (PET) revealed an abnormal uptake only in station 11i lymph node (standardized uptake value: 5.1), whereas no marked accumulation was observed in the right lower mass.

Source: International journal of surgery case reports

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