Abstract
Purpose
To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL).
Methods
Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL.
Results
The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%).
Conclusion
We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.
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References
Appleton AB. Segments and blood-vessels of lungs. Lancet. 1944;244:592–4.
Boyden EA. The intrahilar and related segmental anatomy of the lung. Surgery. 1945;18:706–31.
Clagett OT, Deterling RA Jr. A technique for segmental pulmonary resection with particular reference to lingulectomy. J Thorac Surg. 1946;15:227–38.
Ramsay BH. The anatomic guide to the intersegmental plane. Surgery. 1949;25:533–8.
Kent EM. The surgical importance of the anatomical distribution of the pulmonary segments. Am Rev Tuberc. 1949;60:699–705.
Berg RM, Boyden EA, Smith FR. An analysis of variations of the segmental bronchi of the left lower lobe of 50 dissected, and ten injected lungs. J Thorac Surg. 1949;18:216–37.
Smith FR, Boyden EA. An analysis of variations of the segmental bronchi of the right lower lobe of 50 injected lungs. J Thorac Surg. 1949;18:195–21515.
NOMENCLATUR of broncho-pulmonary anatomy; an international nomenclature accepted by the Thoracic Society. Thorax. 1950;5:222–28.
Yamashita H. Variations in the pulmonary segments and the bronchovascular trees. Roentgenologic anatomy of the lung. Tokyo: Igaku-syoin; 1978.
Zhao X, Ju Y, Liu C, Li J, Huang M, Sun J, et al. Bronchial anatomy of left lung: a study of multi-detector row CT. Surg Radiol Anat. 2009;31:85–91.
Akiba T, Marushima H, Odaka M, Harada J, Kobayashi S, Morikawa T. Pulmonary vein analysis using three-dimensional computed tomography angiography for thoracic surgery. Gen Thorac Cardiovasc Surg. 2010;58:331–5.
Ishikawa Y, Iwano S, Usami N, Yokoi K. An anomalous segmental vein of the left upper lobe of the lung: preoperative identification by three-dimensional computed tomography pulmonary angiography. Interact Cardiovasc Thorac Surg. 2012;15:512–3.
Nagashima T, Shimizu K, Ohtaki Y, Obayashi K, Kakegawa S, Nakazawa S, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg. 2015;63:354–60.
Nagashima T, Shimizu K, Ohtaki Y, Obayashi K, Nakazawa S, Mogi A, et al. Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg. 2017;65:343–9.
Nakashima S, Watanabe A, Ogura K, Higami T. Advantages of preoperative three-dimensional contrast-enhanced computed tomography for anomalous pulmonary artery in video-assisted thoracoscopic segmentectomy. Eur J Cardiothorac Surg. 2010;38:388.
Yim AP, Izzat MB, Liu HP, Ma CC. Thoracoscopic major lung resections: an Asian perspective. Semin Thorac Cardiovasc Surg. 1998;10:326–31.
Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg. 2009;35:775–80.
Kanzaki M, Maeda H, Wachi N, Kikkawa T, Komine H, Isaka T, et al. Complete video-assisted thoracoscopic multi-subsegmentectomy based on patients' specific virtual 3-D pulmonary models. Asian J Endosc Surg. 2013;6:110–5.
Wu WB, Xu XF, Wen W, Xu J, Zhu Q, Chen L. Thoracoscopic pulmonary sub-subsegmentectomy based on three-dimensional images. Ann Thorac Surg. 2016;102:389–91.
Houg JH, Kim HJ, Han DH, Sung SH, Ahn MI, Jung JI. Arteria praebronchialis found on MDCT: potentially dangerous aberrant artery supplying the left lower lobe. Surg Radiol Anat. 2015;37:1021–6.
Chassagnon G, Morel B, Carpentier E, Ducou Le Pointe H, Sirinelli D. Lobe-based classification scheme. Radiographics. 2016;36:358–73.
Matumoto I, Ohta Y, Tsunezuka Y, Sawa S, Fujii S, Saito K, et al. A surgical case of lung cancer in a patient with the left superior and inferior pulmonary veins forming a common trunk. Ann Thorac Cardiovasc Surg. 2005;11:316–9.
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Ryunosuke Maki and the co-authors have no conflicts of interest to declare.
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Maki, R., Miyajima, M., Ogura, K. et al. Pulmonary vessels and bronchial anatomy of the left lower lobe. Surg Today 50, 1081–1090 (2020). https://doi.org/10.1007/s00595-020-01991-y
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DOI: https://doi.org/10.1007/s00595-020-01991-y