Role of 3-Dimentional Computed Tomography Scan in Video Assisted Major Pulmonary Resection in Patient with Situs Inversus Totalis

Abstract

The aim of this case report is to raise awareness about the use of 3-Dimentional Computed Tomography (3D-CT) virtual reality imaging as a routine pre-operative tool for evaluation of unusual anatomy such as Situs Inversus Totalis (SIT). We present a case of presumed lung cancer in a 58 years old lady with SIT successfully treated by VATS lobectomy via an anterior approach. She presented with an incidental solitary pulmonary nodule in her right lower lobe, which had moderate FDG uptake on the PET scan. The nodule was too deep to permit safe wedge biopsy, due to proximity of a large pulmonary arterial branch. 3D-CT images were invaluable in pre-operative assessment of the anatomy and w ere the key to safe completion of right VATS lower lobectomy. Sectioning the lung after retrieval of the specimen suggested a chondroid hamartoma ; therefore , systemic nodal dissection (SND) was not contemplated. The final histology confirmed the diagnosis of chondroid hamartoma. In an unusual anatomy such as SIT, 3D-CT allows construction of virtual reality models that can be viewed and manipulated before and during the operation to understand the anatomy better, highlight caveats around target structures and enable localisation of lesions unlikely to be palpated intra-operatively.