Thoracoscopic segmentectomy assisted by three-dimensional computed tomography bronchography and angiography for lung cancer in a patient living with situs inversus totalis: A case report

Figure 1 Computed tomography images. A: Mixed ground-glass opacity measuring 1.2 cm in diameter with a solid component of approximately 0.6 cm in the posterior segment of the left upper lobe (LS²); B: Complete mirror image of the segmental vessels and bronchus of LS²; C: Situs inversus totalis (dextrocardia, aortic arch, spleen, and liver). AscA: Ascending artery.

Figure 2 Intraoperative views. A: Computed tomography-guided hookwire localization for the mixed ground-glass opacity (mGGO) lesion; B: Intersegmental demarcation identified by an improved inflation-deflation method; C: Stumps of targeted bronchi and vessels; D: The mGGO lesion.

Figure 3 Three-dimensional images reconstructed with OsiriX software. A and B: Three-dimensional structure and spatial relation of bronchi and blood vessels; C and D: Exact three-dimensional computed tomography bronchography and angiography relationships between the mixed ground-glass opacity (mGGO) lesion and pulmonary anatomical structures. Green: The mGGO lesion; Yellow: Pulmonary veins; Red: Pulmonary artery; White: Bronchus. The blue dotted line denotes the safety margin. 3D-CTBA: Three-dimensional computed tomography bronchography and angiography; mGGO: Mixed ground-glass opacity.

Figure 4 Final pathology of the tumor indicated in situ adenocarcinoma (×200).