Three-dimensional imaging for thoracoscopic resection of complex lung anomalies

BACKGROUND Building surgical strategies for complex lung anomalies such as congenital pulmonary venolobar syndrome is difficult because of their rarity and variance. Using three-dimensional computed tomography (3D-CT), we can determine strategies safely. We describe a 27-year-old man with multifocal pulmonary malformations who underwent video-assisted thoracoscopic surgery (VATS) using 3D-CT. CASE PRESENTATION A 27-year-old man presented with hemoptysis associated with complex pulmonary malformations, including a triple-arched vein connecting the superior and inferior pulmonary veins with partial drainage into the inferior vena cava, a systemic and numerous arterial supply to the right lower lobe from the abdominal aorta, abnormal lobulation, and a tracheal bronchus in the right lung. Preoperative simulation using 3D-CT helped to determine the optimal surgical strategy, allowing for successful and safe completion of semi-emergent middle and lower bilobectomy via minimally invasive VATS. CONCLUSIONS Preoperative simulation using 3D-CT helped to determine the optimal surgical strategy, allowing for successful and safe completion of surgery even in a complex case.