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Introduction We present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC). Discussion It is only in the minority of PAPVR cases where the anomalous pulmonary veins cross the midline. We provide a review of current literature on this topic and an explanatory embryological model. Knowledge of embryonic development and possible anatomic variations, including the concept of dual venous drainage of the lung, leads to better interpretation of imaging, with more accurate description of the morphology at hand. High-resolution multidetector computed tomography (MDCT) helps to delineate the exact vascular anatomy. This will enhance a better understanding of and anticipation on the patient’s disease status, with more accurate planning of intervention, and possibly less complications.

A 63-year-old asymptomatic woman with abnormal chest shadow was referred to our hospital. The patient was a never smoker, and had a history of bronchial asthma and hypertension. Chest CT revealed a 4 cm diameter tumour in the right upper lobe, two nodules accompanied spicula and pleural indentation

Ectopic pancreas within the anterior mediastinum is a rare congenital anomaly. We present a case of a solid anterior mediastinal mass that presented with hemoptysis and ground glass parenchymal changes in the right upper lobe. Robotic surgical resection was completed, and final pathology was consistent with benign pancreatic tissue. The patient fully recovered with no recurrence of hemoptysis. Ectopic pancreas, although uncommon, should be included in the differential for solid and cystic anterior mediastinal masses, and surgical resection is often curative and effectively manages symptoms.

A 57-year-old man visited a referral physician due to abnormal chest shadows. Transbronchial lung biopsy (TBLB) failed to diagnose his condition. As antibiotics and systemic steroids did not improve the condition, he was referred to our hospital. A second TBLB in our hospital also failed to diagnose the disease. Transbronchial lung cryobiopsy (TBLC) was performed using radial endobronchial ultrasound with guide sheath (EBUS-GS), and the patient was diagnosed with lipoid pneumonia. Right upper lobe resection was performed, and lipoid pneumonia was confirmed from the surgical specimen. We report a case of lipoid pneumonia diagnosed by EBUS-GS TBLC.

Background Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. Case presentation Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. Conclusion Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

Significance Orbital emphysema is a well-documented condition where air enters the orbital soft tissue typically because of direct or indirect trauma; however, atraumatic cases can be encountered. The following is a novel case report of acute unilateral atraumatic orbital emphysema 24 hours after bronchoscopy with endobronchial biopsy. Purpose To the best of the authors' knowledge, this is the first known case report of atraumatic orbital emphysema as a postprocedure complication of bronchoscopy with endobronchial biopsy in the literature. Case report A 74-year-old man presented with painless swelling of the left upper and lower eyelids upon awakening. The patient had a history of bronchoscopy and endobronchial biopsy with conscious sedation for a right upper lobe lung mass 24 hours before the visit. Slit-lamp examination revealed air entrapment in the left upper and lower lids with enlarged subconjunctival air pockets of the left eye. Head and maxillofacial computed tomography without contrast revealed extensive emphysema tracking and dissecting along the subcutaneous and deep soft tissue spaces of the neck and face that was more pronounced along the left side. The patient was admitted for overnight observation and prescribed a prophylactic oral course of 250 mg of azithromycin daily for 2 days by the attending hospitalist. The subsequent follow-up visit 3 days later revealed complete resolution of signs and symptoms. Conclusions This case report demonstrates the importance of considering orbital emphysema in patients with a history of recent bronchoscopy with endobronchial biopsy. Clinicians should be aware of this potential complication and refer for appropriate testing and comanagement.

As regard human anatomy the azygos lobe is considered a congenital anomaly of the upper lobe of the right lung. In embryolog, the pleural septum of the upper lobe the lateral course of azygos vein arises in abnormal manner. It considered not a true lobe as it has no vessels, bronchi or even accessory, pulmonary lobe, but considered separated part of the upper lobe. It is usually discovered accidentally on chest x-ray or computed tomography and is not associated with any morbidity but can cause technical problems in thoraco-scopic maneuvers. Conclusion and Clinical Message Azygos vein laterally displaced into apical segment of right upper lobe leading to deep pleural fissure during embryological development resulting in formation of azygos lobe. No problem or disease result from this anatomical variant but must be considered during thoracic surgeries as also it is not even accessory lobe as it does not has normal structures of true lobe. Azygos lobe is found in 1% of anatomic specimens .

The diagnosis and treatment of massive hemoptysis remain challenging. We report a 28-year-old woman with refractory massive hemoptysis caused by a mediastinal hemangioma. Despite multiple bronchial artery embolizations and fiberoptic bronchoscopy treatments, effective control of the bleeding and clearing of the airway was not possible. Finally, with the support of venovenous extracorporeal membrane oxygenation, mediastinal hemangioma resection and right upper lobe sleeve resection were simultaneously performed. During the operation, many blood clots in the airway were removed. The airway bleeding was effectively controlled, and the patient recovered.

A patient with a history of hepatocellular carcinoma was found to have multiple pulmonary metastases. Staged treatments were combined into a single operation session in the hybrid theater, encompassing bronchoscopic microwave ablation of central right upper lobe lesions and uniportal surgical wedge resections of peripheral right middle lobe lesions. All lung metastases were successfully treated with adequate margin clearance. Microwave ablation under the guidance of electromagnetic navigation bronchoscopy in the hybrid theater is a novel contribution to the multimodal operative management of multiple pulmonary neoplasms. It is a unique choice for patients with multilobar, subcentimeter metastases, and with concerns about lung function preservation.

The transcervical technique of the uniportal Video-Assisted Thoracic Surgery pulmonary lobectomy was described. The patient was a male with cT4N0M0 squamous cell carcinoma of the right upper lobe. The procedure consisted of 2 steps – the first one the Transcervical Extended Mediastinal Lymphadenectomy with removal of mediastinal nodes bilaterally, which were intraoperatively studied with the use of the imprint cytology technique and revealed no metastatic nodes. The second part of the operation was the lobectomy, which was described in detail. Finally, the advantages and disadvantages of this approach were discussed.

Background: In patients with chronic pulmonary microaspiration (CPM) the recognition of high-resolution computed tomographic (HRCT) findings and their pattern is important. Objective: To investigate the HRCT detections in patients with CPM. Materials and Methods: This descriptive study enrolled 100 consecutive patients with CPM underwent HRCT of the lungs between 2017 and 2018 in Tehran and Zahedan Hospitals and private centers. The required variables were recorded for each patient with a questionnaire. Subsequently, HRCT was performed and abnormalities were then reported by two radiologists. Results: Most of patients exhibited bronchial thickening in 33.6% of cases, followed by ground-glass opacity (12.4%), em- physema (11.1%), and bronchiectasis (8.5%). In addition, the most common HRCT findings were found in left lower lobe (LLL) (37.1%), followed by right lower lobe (RLL) (35.9 %), right upper lobe (RUL ) (6,2%), and left upper lobe (LUL) (6%). Conclusion: Our data showed the most common findings in HRCT were bronchial thickening ground-glass opacity, em- physema, and bronchiectasis, where these findings was dominantly found in LLL, RLL, RUL, and LUL, indicating its high tendency to dependent areas. Keywords: Imaging; high-resolution computed tomographic; chronic lung microaspiration.

Background To standardize the technical strategy for right upper lobe (RUL) segmentectomy, we previously developed simplified 3-dimensional (3D) anatomic models that classify the RUL anatomy into 14 patterns according to the branching pattern of bronchi and veins. We aimed to study the surgical outcome of RUL segmentectomy guided by these simplified anatomic models. Methods Patients were classified into the anatomic models, and the approach to the intersegmental veins was selected accordingly. The intersegmental vein and corresponding intersegmental plane were as follows: V1b (the apicoanterior plane), V2a (the apicoposterior plane), and V2c (the posteroanterior plane). Clinicopathologic characteristics and short- and long-term outcomes were analyzed retrospectively. Results Thirty-four consecutive patients who underwent thoracoscopic RUL segmentectomy guided by simplified anatomic models between January 2016 and December 2019 at Gunma University were analyzed. All the patients were classified into a model: anterior + central Iab type (47%), anterior + central Ib type (41%), anterior II type (12%), or central III type (0%). The standard approaches to intersegmental veins were an anterior approach for V1b, a posterobronchial approach for V2a, and an interlobar approach for V2c. The approach to intersegmental or intrasegmental veins was modified according to the anatomic model in 4 cases (12%). The median operative time, blood loss, and hospital stay were 222 minutes, 19 grams, and 7 days, respectively. Prolonged air leakage was observed in 1 patient. Conclusions Segmentectomy guided by simplified anatomic models promotes anatomic classification, development of a standardized approach for segmental vein identification, and acceptable outcomes, which can facilitate the implementation of RUL segmentectomy., Graphical abstract Right upper lobe (RUL) segmentectomy guided by a simplified anatomic model consisting of (1) a 2-step classification of the segmental anatomy into one of 14 anatomic models and (2) a standardized approach to intersegmental veins selected according to the anatomic model. This method led to the successful classification and completion of RUL segmentectomy in 34 consecutive patients.

We report a case of severe emphysema with bullae in a patient who underwent the new technique of bronchoscopic lung volume reduction to the right upper lobe. He was symptomatic with breathlessness and frequent exacerbations. He was not deemed suitable for a surgical lung volume reduction or bullectomy due to a very low forced expiratory volume in one second (FEV1). Endobronchial valves were not considered due to the incomplete fissures. The case was carefully screened, and was discussed in a multidisciplinary meeting prior to the final decision. This was the first case in Malaysia of bronchoscopic thermal vapour ablation (BTVA) for severe advanced emphysema. Multiple experts were involved prior, during and after the procedure. Despite having a poor lung reserve, he came through the procedure successfully with no immediate complications. His serial spirometry showed a 50% improvement at six months compared to baseline. This case highlights the important role of a multidisciplinary meeting, expert opinion and the careful selection of which patients should undergo BTVA. The procedure should be carried out at a centre of excellence in order to achieve a successful procedure.

Synchronous breast and lung cancers are rare and pose technical challenges for radiotherapy management. We present the case of a 63-year-old asymptomatic female with synchronous left breast HER2-positive invasive ductal carcinoma and right upper lobe atypical carcinoid tumor.

Background Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three‐dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground‐glass nodules (GGNs). Methods This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography‐guided (CT‐G) and 3D‐printing template guided (3D‐G) localization to compare the accuracies of the two methods. In the testing period, the 3D‐printing technique was implemented alone. The 3D‐printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D‐printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis. Results In the comparison period (n = 14), the success rates of CT‐G and 3D‐G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D‐G was 95.6%. The localization times of CT‐G, 3D‐G (comparison), and 3D‐G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X2 − 0.013X − 0.454 (R2 = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients). Conclusions 3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery., Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study demonstrated that the 3D printing localization technique is a feasible and accessible strategy to localize non‐palpable pulmonary nodules.

To distinguish whether multiple lung nodules represent multiple primary lung cancers (MPLC) or intrapulmonary metastases (IPM) is crucial for staging and subsequent therapy. We herein present the first report of a patient with two simultaneously resected metachronous lung adenocarcinomas in the right upper lobe, each with a distinct driver mutation in the KRAS gene identified by targeted next generation sequencing (NGS). The nodules appeared chronologically metachronous, with a 3.7 year interval. Histopathology showed two histologically identical adenocarcinomas, without lymph node metastases. It was hard to decide whether they should be classified as either MPLC or IPM based only on the clinicopathological criteria. Sequencing further revealed distinct KRAS mutation in each tumor, with one tumor harboring the KRAS‐G12C mutation, and the other tumor harboring the KRAS‐Q61H mutation. Incorporation of the molecular data cleared the confusion with regard to staging and spared this patient from adjuvant therapy. This case highlights that molecular profiling allows for better differentiation between MPLC and IPM than histopathology alone. Key points To the best of our knowledge, this is the first case of multiple primary lung cancers harboring distinct KRAS mutations. The case highlights the importance of incorporating molecular profiling using NGS along with the clinicopathological criteria in classifying multiple lung tumors.

A 33-year-old previously healthy man from Mexico who presented with massive hemoptysis, fevers, chills and found to have cavitary lesions in the right upper lobe of lung was highly suspicious for tuberculosis. The patient was treated with vancomycin, ceftriaxone, azithromycin and placed on isolation for suspected tuberculosis. Sputum AFB stains were negative and blood cultures grew Group A Streptococcus [GAS]. Antibiotics were narrowed down to ampicillin-sulbactam and the patient was discharged with significant clinical improvement. Strep A pyogenes is a rare cause of cavitary hemorrhagic pneumonia but is associated with high mortality. Clinical suspicion and early diagnosis are crucial in saving the patient.

OBJECTIVES The B3 downwards-shifting malformation was first proposed by Boyden in 1950. Here, we report 14 cases of this malformation in the right lung and the first case of segmentectomy for this malformation. METHODS All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography (3D-CTBA) between January 2019 and January 2020, prior to surgery. A consecutive 2356 patients were included, and 14 cases of this malformation were identified; bronchovascular patterns were analysed in each patient. RESULTS The incidence of this malformation was 0.6%. It was further divided into 3 types: over downwards-shift, partial downwards-shift and normal downwards-shift. The normal downwards-shift type was the most common (8/14), where B3 shifted downwards completely to merge with B4 + 5. In the partial downwards-shift (5/14), only part of the B3 shifted. In the over downwards-shift type (1/14), both B3 and B1b shifted downwards. A bifurcated right upper lobe （RUL) bronchus (B1 defective) was observed in 3 cases. The incidence of V1a, V1b, V2a, V2b, V2c, V3a, V3b and V3c was 100% (14/14). The incidence rates of A1, A3a and A3b were 100% (14/14). The incidence of A2 rec and A2 asc was 92.9% (13/14) and 71.4% (10/14), respectively. CONCLUSIONS The B3 downwards-shifting malformation or ‘Boyden’s triad’ is a rare anomaly. Anatomical exploration of this malformation is important for surgery.

The patient was an 80-year-old woman with combined pulmonary fibrosis and emphysema. She was diagnosed with pulmonary pleomorphic carcinoma in the right upper lobe, which relapsed 18 months after the operation. Computed tomography showed a mass in contact with the posterior wall of the lower part of the stomach. The patient was treated with two cycles of pembrolizumab, but the disease progressed. She was treated with S-1 as second-line therapy, resulting in tumor-shrinking after two cycles. Progression was not observed over the next twelve months. We report a rare case involving S-1 after immune checkpoint inhibitor treatment.

Here we present the case of a 38-year-old man with an incidentally found right upper lobe lung mass. The patient underwent thoracoscopic resection of the mass, which revealed a myxoid spindle cell lipoma. That is an exceedingly rare location for this tumor biology, and here we discuss its pathologic features and treatment options.

Although several cases of thoracic surgery for patients with displaced bronchi have been reported, there are few reports describing the anatomical features of displaced bronchi. The author aimed to analyze the incidence and types of displaced bronchi, and their associated lung lobulations and vascular courses. Of 6480 patients who underwent thoracic computed tomography at our hospital from 2012 to 2016, 6072 were included. Displaced bronchi were classified according to their associated lobes and were subclassified based on each lobar or segmental bronchus. Subsequently, the author analyzed the associated abnormalities of lung lobulations and vascular courses. Of 6072 patients, displaced bronchi were observed in 46 (0.76%): the right upper lobe in 39, the right lower lobe in two, and the left upper lobe in five patients. In the right upper lobe, “Right Upper Lobar Type” was found in six patients “Right B1 Type” in 15, “Right B2 Type” in seven, and “Right B3 Type” in 11 patients. All right lower lobar displaced bronchi were “Right B6 Type” and all left upper lobar displaced bronchi were “Left B1+2 Type”. In the Right B2, Right B3, and Left B1+2 Types, abnormal lung lobulations and top pulmonary veins were frequently noted. All patients with the Right B3 and Left B1+2 Types had unique abnormalities of the pulmonary arteries. In some types of displaced bronchi, both abnormal lobulations and top pulmonary veins may be useful for recognizing displaced bronchi.

We report a case of a 56-year-old man with persistent right upper lobe cavitary mass. A chest computed tomography scan showed about 4-cm-sized mass with internal low attenuation and peripheral enhancement in right upper lobe apical segment. The lesion size increased over 1 month. Right upper lobectomy was performed with the intention to treat the lesion. Pathological examination showed primary pulmonary undifferentiated pleomorphic sarcoma. We describe this rare lung disease to remind that primary pulmonary undifferentiated pleomorphic sarcoma could be the differential diagnosis of pulmonary cavitary mass lesions.

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.

Ciliated muconodular papillary tumors (CMPTs) are rare peripheral lung lesions, characterized by papillary architecture and ciliated columnar cells admixed with mucous cells and basal cells. Only about 50 cases have been reported to date and is categorized as a benign neoplasm. In this article, we report an extremely rare case of 79-year-old man with a CMPT that developed in his right upper lobe. The central region of the tumor showed features of classic CMPT, while marginal area of the tumor showed the characteristics of invasive lung cancer. In central classic CMPT region, the ciliated, basal, and mucous cells were positive for thyroid transcription factor-1, cytokeratin 7 (CK7), and NapsinA. Basal cells were positive for CK5/6 and p40. Mucous cells were weakly positive for MUC2 and MUC5AC. However, CK5/6 and p40 were negative in the peripheral malignant area. Both of the benign and malignant regions had an EGFR driver mutation in exon 21. We concluded that this tumor was an extremely rare malignant case of CMPT.

Heart-Shaped Lesion A 63-year-old man with lung cancer presented for staging imaging. PET-CT revealed a heart-shaped lesion in the right upper lobe.

Videothoracoscopic resections are among the mostly preferred minimally invasive thoracic surgical techniques to treat lung cancers especially in the last two decades. In thoracoscopic surgery video camera technology, high-tech equipment and surgical instruments including staplers are required. We have developed a technique for dissection and cutting of truncus anterior and right upper lobe vein in one step with stapler by this way we aimed to provide less operation time and more cost- effectiveness for right upper lobectomies.

Introduction: The aim of reporting these two cases is to present visual evidence by bronchoscopy of the origin of haemoptysis in two elite breath-hold divers. Case reports: Two male elite breath-hold divers of similar physical characteristics presented to our clinic after performing dives of up to 75 and 59 meters of seawater depth for 2:30 and 2:35 (minutes:seconds) respectively. Both patients presented with haemoptysis. Lung ultrasound was performed. The first patient had crackles on chest auscultation, overt pulmonary oedema clinically and 90 ultrasound lung comets. The second patient had no oedema or crackles, but presented with 20 ultrasound lung comets. Video bronchoscopy was performed which showed traces of blood coming from all three segments of the right upper lobe in both patients. The rest of the airways and lungs were intact. Conclusions: These finding suggest that the apical parts of the lungs are the most prone to deep-dive induced damage. The precise mechanism of lung barotrauma and haemoptysis in breath-hold divers remains to be elucidated. These findings may be of importance for a better understanding of the underlying pathology of haemoptysis.

Pulmonary segmentectomy offers a lung preserving alternative for early-stage lung cancer resection especially for patients with emphysema. Data from several studies has allowed segmentectomy to become a reasonable alternative to standard lobectomy, with no compromise to oncologic survival and the advantage of sparing more viable parenchyma. Minimally invasive robotic techniques have been shown to have similar recurrence and cancer-free survival rates. This chapter focuses on the techniques of robotic upper lobe segmentectomies using Da Vinci Si and Xi platforms. Port placement and technique are discussed for right upper lobe apical segmentectomy (S1), right upper lobe posterior segmentectomy (S2), right upper lobe anterior segmentectomy (S3), left upper lobe upper division segmentectomy (S1 + S2 + S3), and lingular segmentectomy (S4 + S5).

Robotic right upper lobectomy can be safely and consistently performed with excellent perioperative outcomes. This chapter reviews preoperative and intraoperative considerations including aberrant anatomy and difficult fissures. Port placement and robotic setup are reviewed in detail followed by a step-by-step technique that is safe and reproducible. A fissure-first approach is described with full exposure of all bronchovascular structures to the right upper lobe. Lastly, superior and inferior mediastinal lymph node dissections are outlined.

BackgroundComplex aberration in lung is rare, which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery, and result in sever complication like pulmonary congestion or atelectasis. Case presentationIn this case, a 44-year-old female was admitted for ground glass nodule (maximum diameter, 24mm) in right upper lobe. During operation, it was found that extremely rare aberrations of right preeparterial bronchus, right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium occurred in this patient simultaneously. Video-assisted thoracoscopic right upper lobectomy with lymph nodes dissection was performed for adenocarcinoma shown by frozen section. The patient was well recovered and discharged at the postoperative-day 4. Based on the literature review, such complex aberrations of pulmonary vessels and bronchus had seldom been reported before.ConclusionPreoperatively, three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively. During lung surgery, if anatomic aberration is suspected, careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.

Tuberculosis (TB)-infected giant bullae are rare. A 55-year-old man was referred when an infected bulla did not respond to empirical treatment. Computed tomography showed a giant bulla in the right upper lobe with an air-fluid level and surrounding infiltrate. Sputum culture, acid-fast bacilli (AFB) stain, and polymerase chain reaction (PCR) for TB were negative. Percutaneous drainage of the bullous fluid was performed. AFB stain and PCR were positive in the drained fluid. The patient was given anti-TB drugs and later underwent obliteration of the pulmonary cavity using talc. To summarize, we report a patient with a TB-infected giant bulla that was treated successfully with anti-TB drugs and obliteration of the pulmonary cavity using talc.

Uniportal video-assisted thoracic surgery is becoming more common worldwide, but the limited angle of approach of inserted surgical instruments makes it challenging. Because of this, segmentectomy via a uniportal approach is more difficult technically than a multiportal approach. In addition, the inflation/deflation technique, which is a standard method for identifying the intersegmental plane, is often less useful because it can be difficult to get a good surgical view. To resolve this problem, a technique using near infrared imaging and indocyanine green administration technique can be very helpful in performing a uniportal segmentectomy. In this video tutorial, we demonstrate a uniportal thoracoscopic dorsal segmentectomy of the right upper lobe of a patient with primary lung cancer, using a near infrared imaging/indocyanine green technique. We explain the nuances of the procedure and how to perform it, and we discuss our successful results.

Background: The need to determine the aetiology of solitary pulmonary nodules (SPN) is high. The ArchimedesTM System combines virtual bronchoscopy navigation (VBN) with fused fluoroscopy (FF) in order to improve the guidance. Objective: To analyze the feasibility of ArchimedesTM interventions for the diagnosis of SPN. Methods: From 01-05/2020 16 patients with SPN were examined. Based on a specific CT scan the access way to the SPN was calculated and adjusted as needed. Interventions were done in general anesthesia with chest tube. Results: 16 Patients (43,8% female, 56,3% male) aged 64 years (±8,3) were included with a malignancy risk for the SPN (calculated with the Brock Model) of 40,6% (±19,3). SPN measured 14,9mm (±7,1). Localization were 43,8% left upper lobe, 25% right lower lobe, 25% right upper lobe, 6,3% middle lobe. The distance from the last reconstructed bronchus to the lesion was 21,5mm (± 12,7), the distance between target and pleura 20,1mm (± 16,8). Time for calculation 21 minutes (± 10,4), time to location of the SPN 14 minutes (±15,5). Bronchoscope with 4,2mm (93,8%) and 3mm (6,3%) outside diameter were used. The lesion could be seen in radial EBUS in 87,5% (50% adjacent, 25% central, 12,5% stop phenomenon). There were no major complications (25% mild bleeding managed by suction, no pneumothoraxes). Sensitivity was calculated 71,4%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 33,3% and accuracy 75%. Conclusion: A high diagnostic yield for small peripheral SPN can be achieved with ArchimedesTM interventions even if the distance from the last reconstructed bronchus to the target is over 20mm.

Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. Conservative treatment is full‐fledged for uncomplicated cases. We presented here an 18‐year‐old young adult with chest trauma caused by a fall. Chest computed tomography disclosed a cavitary lesion 10.5 × 8.5 × 6.4 cm3 over right upper lobe (RUL) with bilateral lower lung contusion and a mild haemopneumothorax but without rib fractures. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes., Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. To the best of our knowledge, we present here a case of the largest TP without rib fracture. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes.