Variations of pulmonary vein drainage critical for lung resection assessed by three‐dimensional computed tomography angiography

Abstract

BackgroundIt is important to understand pulmonary vein drainage pattern variations and their frequency in order to perform safe anatomical pulmonary resection.MethodsVariations and frequencies were assessed using three‐dimensional computed tomography angiography (3D‐CT) in 194 patients. In cases where the tumor or lymph node caused atelectasis or compression of hilar structures, the involved lobes were excluded from the analyses.ResultsWe confirmed variant drainage patterns in 15/189 (8.0%) patients in the right upper lobe (RUL), 29/189 (15.3%) in the right middle lobe (RML), 18/192 (9.5%) in the right lower lobe (RLL), and 5/187 (2.6%) in the left upper lobe (LUL). There was no variant type in the left lower lobe (LLL). There were 14 (7.4%) cases of anomalous superior posterior pulmonary vein of RUL (V2) drainage: V2 draining to the superior pulmonary vein (SPV) (n = 2, 1.1%), V2 to the inferior pulmonary vein (IPV) (n = 7, 3.7%), V2 to the left atrium (LA) (n = 2, 1.1%), and V6 to the apical pulmonary vein of the RLL (n = 3, 1.6%). There was a posterior pulmonary vein, V3 to RML pulmonary vein in one case (0.5%). The RML pulmonary vein drained into the IPV in 14 (7.4%) and into the LA in 15 (7.9%) cases. The right V6 directly drained into the LA in 15 (7.9%) and V6 into the SPV in 3 (1.6%) cases. The lingular pulmonary vein drained into the IPV in one case (0.5%) and into the LA in two cases (1.1%). The inferior lingular pulmonary vein V5 drained into the IPV and into the LA in one case (0.5%), respectively.ConclusionWe describe anomalous pulmonary venous drainage patterns and their frequencies particular to anatomic surgical resection. 3D‐CT is useful to find such variations.

Unusual pulmonary vein variant in a patient with right upper lobe lung cancer

“…Recently, pulmonary veins have been evaluated preoperatively using 3D-CT, and various drainage patterns have been identified. These reports concluded that 3D-CT was a useful tool for the evaluation of individual anatomical variations preoperatively for performing VATS [ 1 , 2 ]. The frequency of abnormal pulmonary venous return in the right side (32.8%) is higher than that in the left side (2.6%), and anomalous venous return of right V2 is more common [ 2 ].…”

“…These reports concluded that 3D-CT was a useful tool for the evaluation of individual anatomical variations preoperatively for performing VATS [ 1 , 2 ]. The frequency of abnormal pulmonary venous return in the right side (32.8%) is higher than that in the left side (2.6%), and anomalous venous return of right V2 is more common [ 2 ]. The right upper lobe pulmonary vein is usually located anterior to the hilum, and the pulmonary artery located just posterior to it.…”

“…As a result, precise information about individual anatomical variations of the pulmonary vessels is available before surgery. In particular, preoperative three-dimensional computed tomography (3D-CT) images have provided accurate information on vascular abnormalities, and 3D-CT images can play an important role for VATS anatomical resection [ 1 , 2 ].…”

Swimming-Induced Pulmonary Edema

“…32 Individual variations of venous drainage from the right lung vein to the left atrium can also predispose for right-sided unilateral pulmonary edema. 33 Only four of the 11 patients reported aspiration of water during swimming, and a majority were swimming breaststroke, leaving us with no obvious explanation for these unilateral findings.…”

Right Apical-Posterior Segmentectomy with Abnormal Anterior Segmental Bronchus and Artery: A Case Report

“…Unawareness of such anomalies could lead to intraoperative and postoperative complications, especially when using a thoracoscopic approach. There has been a small number of surgical cases reporting apical and posterior bronchial (B1 and B2) abnormalities 3,4 , however, report of segmentectomy involving anterior segmental bronchus (B3) and artery (A3) is still scant.…”