Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography

Abstract

ObjectivesGeneral thoracic surgeons must be familiar with anatomical variation in the pulmonary vessels and bronchi. Here, we analyzed the bronchovascular pattern of the right middle lobe (RML) and right lower lobe (RLL) of the lung using three-dimensional CT angiography and bronchography (3DCTAB).MethodsWe reviewed the anatomical patterns of the pulmonary vessels and bronchi in 270 patients using 3DCTAB images.ResultsThe branching patterns of vessels and bronchi of RML and S6 were classified according to the number of stems. The single-stem type was the most common, except in the artery of the RML, for which the two-stem type was the most common. The artery and bronchus of S*, which is an independent segment between S6 and S10, were observed in 20.4% of cases. The branching pattern of A7 (B7) was classified into four types. The A7a (B7a) type was observed in 74.8% of cases, and was the most common. The branching pattern of the artery and bronchus of S8−10 was classified into five and three types, respectively. The A8 and A9 + A10 type, and the B8 and B9 + B10 type, were observed in 68.1 and 80.4% of cases, respectively, and were the most common types. The branching pattern of V8−10 was more complex than that of A8−10 and B8−10.ConclusionWe explored the bronchovascular patterns of RML and RLL and their frequencies using a large number of 3DCTAB images. Our data can be used by thoracic surgeons to perform safe and precise lung resections.Electronic supplementary materialThe online version of this article (doi:10.1007/s11748-017-0754-4) contains supplementary material, which is available to authorized users.

An aberrant mediastinal medial basal segmental pulmonary artery (A7a) in a patient with lung cancer: a case report

“…Although a previous report showed various patterns of branches of PA and bronchus in the right lung using 3D-CT, no reports have revealed that only A7a branched from the right main PA [ 3 ]. Only two case reports identified lung resections with A7 branching from the right main PA [ 1 , 2 ].…”

“…According to a previous report, the branching pattern of B7 and A7 was classified into four types: B 7 a type, B 7 ab type, B 7 b type, and BX 7 type. The B 7 a was the most common (74.8%) among the other types: B 7 ab type (14.8%), B 7 b type (4.8%), and BX 7 type (5.6%) [ 3 ]. In our case, the PA pattern and bronchus branching were compatible with the B 7 ab type, in which there are two bronchi (B7a and B7b) and two arteries (A7a and A7b).…”

A case of thoracoscopic medial basal segmentectomy

“…Anatomical variation also makes it difficult to perform S7 segmentectomy. Chujo et al [5] and Nagashima et al [6] independently reported on the anatomical variations of S7. Chujo et al classified the patterns of B7 and A7 branching into 5 types, while Nagashima et al classified the B7 branching patterns into 4 types.…”

3D-CT anatomy for VATS segmentectomy

“…The anatomical patterns are diverse, and the spatial configuration of the arteries, veins, and bronchi makes the entire picture even more difficult to understand. 3D-CTAB allows a 360-degree view of lung anatomy, and leads to rapid and intuitive recognition of individual anatomical patterns (22,26,27). By recognizing the branching pattern and spatial configuration of a patient's anatomy, 3D-CTAB allows the surgeon to plan anatomical segmentectomy preoperatively by deciding which intersegmental veins should be used as landmarks, which artery/vein/bronchi should be dissected, and in what order.…”