Right lower lobectomy for lung cancer with anterior truncal basal pulmonary artery: A case report

Although anatomical variations in pulmonary arterial branching are relatively common, the presence of an anterior truncal basal pulmonary artery is extremely rare. We herein report a unique case of right lower lobe lung cancer associated with an aberrant mediastinal A7 + 8 + 9 + 10(b + c) artery, successfully managed with thoracoscopic right lower lobectomy. A 76-year-old man presented with a gradually enlarging part-solid ground-glass opacity in segment 10 of the right lower lobe, clinically diagnosed as stage cT1aN0M0, stage IA1 adenocarcinoma. Contrast-enhanced imaging was not possible due to an allergy to iodinated contrast; however, high-resolution CT revealed an aberrant basal pulmonary artery that originated from the right main pulmonary artery and coursed medially into the lower lobe. Three-dimensional preoperative reconstruction was limited due to the lack of contrast enhancement. Video-assisted thoracoscopic right lower lobectomy was performed after wedge resection confirmed malignancy. Pathological staging was pT1aN0M0, stage IA1. The patient had an uneventful postoperative course and remains recurrence-free at 1 year. This case highlights the importance of detailed preoperative imaging review, particularly when contrast-enhanced computed tomography is contraindicated. A careful assessment of High-resolution computed tomography in multiple planes and an awareness of radiographic signs are essential for detecting rare vascular anomalies and ensuring safe surgical outcomes.