Lingular division of the left lung: Only superior and inferior bronchi?

Abstract

The lingular segment bronchi usually bifurcate into superior lingular (B4) and inferior lingular (B5) segmental bronchi. We report 32 horizontally bifurcated lingular segment bronchi cases, analyzing the bronchovascular variations and the perioperative outcomes. All patients with pulmonary lesions underwent three‐dimensional computed tomography bronchography and angiography between January 2019 and January 2022. The bronchovascular patterns were analyzed for each patient. A consecutive 5280 patients were included, and 32 cases of this malformation were identified. The incidence of the lateral (B4) and medial (B5) lingular segmental bronchi is 0.6%. The A4 and A5 arise separately in 21 (65.6%) patients. In 9 (28.1%) patients, the A4a arises from the common trunk of A4 + 5. In 2 (6.3%) patients, the A4 arises from the interlobe artery, while A5 is a mediastinal lingular artery. The common trunk of V4a + b is found in 19 (59.4%) patients. The V5 is the least changeable of the segmental bronchi veins. Among the 32 patients, five patients had an LS4 segmentectomy. The surgical details of the five patients are summarized. The laterally and medially bifurcated lingular bronchus pattern is a rare anomaly. It implies that the lingular bronchus is not only superiorly and inferiorly bifurcated.

Analysis of variations in the bronchovascular pattern of the lingular segment to explore the correlations between the lingular segment artery and left superior division veins

“…Thus, it is extremely easy to mistake the inferior division of the upper lobe bronchus (B5) for B4 + B5 during LS segmentectomy, which will narrow the intersegmental plane. We found horizontally bifurcated lingular segment bronchus in 12 cases (2.2%), which was higher than that reported by Maki (1.5%) and Zhang (0.6%) ( 8 , 9 ). This distinctive branching pattern is shown in Figure 1 .…”

“…We found horizontally bifurcated lingular segment bronchus in 12 cases 3D reconstruction and intraoperative scenario of two basic approaches identifying MLA, PI and PÍ. (2.2%), which was higher than that reported by Maki (1.5%) and Zhang (0.6%) (8,9). This distinctive branching pattern is shown in Figure 1.…”

“…However, there are only a few reports that have comprehensively summarized and classified the bronchovascular pattern of LS using 3D-CTBA. In this study, we analyzed the bronchovascular patterns of the LS and emphasized the differences between our results and those of previous reports (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

“…In this study, the origins of LSB were divided into two types (Table 1, Figure 1). B4 from the central division of the upper lobe bronchus and B5 from the inferior division of the upper lobe bronchus was a rare anomaly (4.4%), which has not been reported in the literature (8,9,12). Thus, it is extremely easy to mistake the inferior division of the upper lobe bronchus (B5) for B4 + B5 during LS segmentectomy, which will narrow the intersegmental plane.…”

“…Some studies revealed that an intraoperative lingular segment artery (LSA) injury was more common during the left upper lobe (LUL) lobectomy ( 6 , 7 ). However, there are only a few studies describing anatomic variations of the lingular segment (LS) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) ( 8 ). In our clinical practice, the anatomical variation of the lingular segment bronchus (LSB) does not accordant with the previous reports ( 9 , 10 ).…”