What happened, in summary

A 61-year-old man was referred for surgery after lung adenocarcinoma was found in the right upper lobe. The cancer was staged clinically as T1cN0M0, with no lymph-node or distant spread identified, and his cardiopulmonary testing was normal. Echocardiography also showed no abnormality. Before the operation, the team carefully reviewed his chest CT and 3D reconstruction. Imaging showed an unusual vascular finding: the pulmonary vein draining the right upper lobe did not follow the expected route and instead drained directly into the superior vena cava. This mattered because an unexpected vein in that location can be injured during lung surgery and cause major bleeding. With the anatomy mapped in advance, surgeons proceeded with a standard 3-port thoracoscopic approach. During the operation, the right upper lobe and middle lobe were mobilized, and the middle-lobe vein was found in the expected location. The abnormal right-upper-lobe vein was then identified after adhesions between the apical segment and the vena cava were dissected. The anomalous vein was divided with a stapler, and the right upper lobectomy was completed in the standard manner. There were no intraoperative or postoperative complications. His chest drain was removed on postoperative day 2, and he went home the next day. Final pathology confirmed pT1cN0M0 adenocarcinoma, so no additional treatment was needed. At 3 months of follow-up, he was well and had no recurrence. The case shows how detailed preoperative imaging can make lung cancer surgery safer when rare vascular anatomy is present. Recognizing the vein before surgery helped the team avoid an unexpected vascular complication.