Surgery for lung cancer in patients who have a cardiovascular anomaly can bring unexpected major hemorrhage or can disturb lymph node dissection. Recently we have performed video-assisted thoracic surgery (VATS) left upper lobectomy + ND2a-2 for cancer of the left upper lobe of lung in a patient who had a persistent left superior vena cava. The case involved a 64-year-old woman who was found having a 27 × 20 mm nodule shadow in the left S1 + 2 as well as a left superior vena cava on a chest CT scan. The accessory hemiazygos vein was found to have passed along the arch of the aorta, from the dorsal to the ventral aspect, to inflow into the left superior vena cava. We thus performed lymph node (#5) dissection while the accessory hemiazygos vein was taped up.

The persistent left superior vena cava is classified into three types according to Keith and that in our case is classified into one from the group (a) where the persistent left superior vena cava opens at the coronary sinus and surgery for it is unnecessary if any cardiac anomaly is absent. With preoperative CT scan to confirm that there was no communication between the left superior vena cava and the pulmonary vein and intraoperative careful identification of vessels, we could safely perform VATS left upper lobectomy.