What happened, in summary

A 74-year-old asymptomatic woman had a right lower-lobe lung shadow found incidentally on CT performed after chest trauma. The scan showed a 24 mm ground-glass opacity with a cavity in the right lower lobe and an anatomical heart-lung vessel variation called partial anomalous pulmonary venous connection, or PAPVC, in the right upper lobe. The PAPVC drained the right upper-lobe pulmonary vein into the superior vena cava. Clinically, the lung lesion was suspected to be Stage IA1 lung cancer, cT1miN0M0. A preoperative transbronchial biopsy was not done because CT did not identify a bronchus leading to the tumor. Before surgery, the team checked whether removing the right lower lobe would overload the right side of the heart. Echocardiography showed no atrial septal defect or abnormal cardiovascular activity, and catheter testing showed a pulmonary-to-systemic flow ratio, Qp/Qs, of 0.98. Because repair of PAPVC is usually considered when symptoms are present and Qp/Qs is much higher, the team planned lung surgery without PAPVC repair. Intraoperative fine-needle aspiration cytology suggested non-small-cell lung cancer. She underwent right lower lobectomy with lymph-node dissection. Final pathology showed primary papillary lung adenocarcinoma, 2.1 cm in maximum diameter with 1.5 cm invasive diameter, staged pT1bN0M0, Stage IA2. Her postoperative course was uneventful. Follow-up echocardiography at 6 months showed no increased right-heart load, and at 12 months she had no lung cancer recurrence or cardiovascular events. Pulmonary function was adequate before surgery, with forced expiratory volume in 1 second of 1.96 L and forced vital capacity of 2.73 L.