Sequential unilateral lung volume reduction surgery in the setting of an azygos lobe: a case report

Lung volume reduction surgery (LVRS) is a thoracic surgical procedure traditionally associated with high morbidity and mortality. Patient selection is crucial in this morbid population with focus on pulmonary function and distribution of lung disease. In a setting where outcomes reflect a balance between removal of diseased lung without removal of excessive volumes of healthier lung, straight forward pulmonary anatomy is ideal. We present a case where aberrant pulmonary anatomy, the presence of an azygos lobe, and borderline respiratory function required a unique surgical approach. Sequential lung reduction was performed, as opposed to the more traditional bilateral technique, allowing for interim reevaluation after the initial, more complicated, side was complete. LVRS can have significant benefit for those with severe COPD however it also brings significant morbidity for those not within the narrow therapeutic window. Bilateral reduction has traditionally demonstrated the greatest benefit for those that meet strict preoperative criteria. Patient complexity often makes concurrent bilateral pulmonary resection hazardous and sequential unilateral reduction may offer a beneficial approach with less upfront risk.