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Surgical and Radiologic Anatomy

, Volume 40, Issue 1, pp 45–53 | Cite as

Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree

  • Alex FourdrainEmail author
  • Florence De Dominicis
  • Chloé Blanchard
  • Jules Iquille
  • Sophie Lafitte
  • Pierre-Louis Beuvry
  • David Michel
  • Geoni Merlusca
  • Eric Havet
  • Pascal Berna
Original Article

Abstract

Purpose

Anatomic variations of the pulmonary arterial tree can cause technical difficulties during pulmonary lobectomy in general and video-assisted thoracic surgery (VATS). Using CT angiography and 3D reconstruction, we sought to identify anatomic variations of the pulmonary arterial tree and assess their respective frequencies.

Methods

We retrospectively studied 88 pulmonary arterial trees in 44 patients having undergone VATS lobectomy for lung cancer over an 18-month period in Amiens University Hospital’s Department of Thoracic Surgery. Each CT angiography with 3D reconstruction of the pulmonary arterial tree was performed by two experienced operators, according to a standardized procedure.

Results

On the right side, the upper lobe was supplied with blood by a mediastinal artery in 100% of cases and by one or more fissural arteries in 88.6%. The middle lobe was usually supplied by two arteries (54.5%). The upper segment of the right lower lobe was usually supplied by a single artery (90.9%). We identified 11 variations in the vasculature of the basal segments. On the left side, the upper lobe was supplied by four arteries in 50% of cases, three culminal arteries (50%), and a fissural lingular artery (77.3%). The upper segment of the left lower lobe was usually supplied by a single artery (65.9%). We identified 15 anatomic variations in the vasculature of the basal segments. We observed that the origin of the apical artery of the right lower lobe was proximal to the origin of the middle lobe artery in 38.6% of cases. The origin of the apical artery of the left lower lobe artery was proximal to the origin of the lingular fissural artery in 65.9% of cases.

Conclusion

The findings of the present CT angiography/3D reconstruction study agreed with the reference works on the anatomy of the pulmonary arterial tree and defined the frequency of anatomic variations. It is essential to assess the anatomy of the pulmonary arterial tree before VATS lobectomy.

Keywords

Pulmonary artery Anatomic variation CT angiography 3D reconstruction Video-assisted thoracic surgery lobectomy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Boyden EA (1955) Segmental anatomy of the lungs. McGraw-Hill, New York, pp 23–32Google Scholar
  2. 2.
    Bulow T, Wiemker R, Blaffert T, Lorenz C, Renisch S (2005) Automatic extraction of the pulmonary artery tree from multi-slice CT data. SPIE Med Imaging 5746:730–740Google Scholar
  3. 3.
    Brouchet L, Marcheix B, Renaud C, Berjaud J, Dahan M (2005) Exérèses pulmonaires partielles. EMC, techniques chirurgicales thorax. Elsevier SAS, Paris, pp 42–350Google Scholar
  4. 4.
    Cordier G, Cabrol C (1953) Artères du lobe supérieur du poumon droit. Arch Anat Pathol 29ème année 1(5):2–8Google Scholar
  5. 5.
    Cordier G, Cabrol C (1954) Artères du lobe supérieur du poumon gauche. Arch Anat Pathol 30ème année 2(1):7–10Google Scholar
  6. 6.
    Cory R, Valentine E (1959) Varying patterns of the lobar branches of the pulmonary artery. Thorax 14:267–280CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Fourdrain A, De Dominicis F, Bensussan M, Iquille J, Lafitte S, Michel D, Berna P (2016) Three-dimensional CT angiography of the pulmonary veins and their anatomical variations: involvement in VATS-lobectomy for lung cancer. Folia Morphol (Warsz). doi: 10.5603/FM.a2016.0081 Google Scholar
  8. 8.
    Fukuhara K, Akashi A, Nakane S, Tomita E (2008) Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy. Eur J Cardiothorac Surg 34:875–877CrossRefPubMedGoogle Scholar
  9. 9.
    Jardin M, Remy J (1986) Segmental bronchovascular anatomy of the lower lobes: CT analysis. AJR Am J Roentgenol 147:457–468CrossRefPubMedGoogle Scholar
  10. 10.
    Lee KS, Bae WK, Lee BH, Kim IY, Choi EW, Lee BH (1991) Bronchovascular anatomy of the upper lobes: evaluation with thin-section CT. Radiology 181:765–772CrossRefPubMedGoogle Scholar
  11. 11.
    Maciejewski R (1991) Branches of the right pulmonary artery to the right upper lobe of the lung. Folia Morphol 50:179–186Google Scholar
  12. 12.
    Maciejewski R (1991) Branches of the right pulmonary artery to the middle lobe of the right lung. Folia Morphol 50:187–192Google Scholar
  13. 13.
    Maciejewski R (1991) Branches of the left pulmonary artery supplying the basal segments of the lung. Acta Anat 140:284–286CrossRefPubMedGoogle Scholar
  14. 14.
    Maciejewski R (1992) Branches of the right pulmonary artery supplying the basal segments of the lung. Acta Anat 145:244–247CrossRefPubMedGoogle Scholar
  15. 15.
    Maciejewski R, Kutnick B (1990) Branches of the left pulmonary artery vascularizing the left upper pulmonary lobe. Acta Anat 138:224–229CrossRefPubMedGoogle Scholar
  16. 16.
    Murota M, Yamamoto Y, Satoh K, Ishimura M, Gotoh M, Nishiyama Y (2015) Preoperative evaluation of the right upper lobe pulmonary artery by 3D-CT pulmonary angiography vs. thin-section multiplanar reconstruction images obtained by contrast-enhanced multidetector-row CT. Acta Med Okayama 69(6):327–332PubMedGoogle Scholar
  17. 17.
    Yamashita H (1978) Roentgenologic anatomy of the lung. Igaku-Shoin, Tokyo, pp 70–94Google Scholar

Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • Alex Fourdrain
    • 1
    • 2
    Email author
  • Florence De Dominicis
    • 1
  • Chloé Blanchard
    • 1
  • Jules Iquille
    • 1
  • Sophie Lafitte
    • 1
  • Pierre-Louis Beuvry
    • 1
  • David Michel
    • 3
  • Geoni Merlusca
    • 1
  • Eric Havet
    • 2
  • Pascal Berna
    • 1
  1. 1.Thoracic Surgery Department, Amiens University HospitalUniversity of PicardyAmiens cedex 01France
  2. 2.Laboratory of Anatomy and OrganogenesisJules Verne University of PicardyAmiensFrance
  3. 3.Diagnostic Radiology DepartmentAmiens University HospitalAmiensFrance

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