An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography

Abstract

ObjectivesGeneral thoracic surgeons must be familiar with anatomical variations in the pulmonary bronchi and vessels. We analyzed variations in the bronchovascular pattern of the right upper lung lobe using three-dimensional CT angiography and bronchography and then compared our results with those of previous reports.MethodsWe reviewed anatomical variations in the right upper pulmonary bronchus and vessels of 263 patients using 3DCT angiography and bronchography images obtained using a 64-channel multidetector CT and workstation running volume-rendering reconstruction software.ResultsVariations in the pulmonary vein were classified into four types: the “anterior-plus-central vein type” was the most common, noted in 219 cases (83.2 %). The “anterior vein type” was evident in 23 cases (8.8 %), a significantly lower incidence than in previous reports (p < 0.001). Also, the branching patterns of the segmental arteries of the pulmonary artery differed partially from those noted in previous reports. Furthermore, we identified some new variations. The “B1- or B2-defective branch type” bronchus was noted in 19 cases (7.2 %), which was a higher prevalence than that in previous reports.ConclusionWe explored the bronchovascular pattern and the frequency of variations in the right upper lobe using a large number of 3DCT images. The incidences of variations differed, sometimes significantly, from those noted by previous reports. Moreover, we report some new branching variations. 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/s11748-015-0531-1) contains supplementary material, which is available to authorized users.

3D-CT anatomy for VATS segmentectomy

“…Thus, the technique may be considered feasible. According to these studies, undetected pulmonary arteries were 1-2 mm in diameter (22)(23)(24)(25).…”

“…Our method for 3D-CTAB image reconstruction was previously reported (22). Briefly, we use 64-channel MDCT (SOMATOM Definition Flash; Siemens Healthcare, Berlin, Germany) for scanning.…”

“…More than 95% of pulmonary arteries are correctly detected by 3D-CTAB [reported values: 98.7% (22), 95.2% (23), 95% (24), and 97.8% (25)]. Thus, the technique may be considered feasible.…”

“…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.…”

3D CT simulation in minimally invasive thoracic surgery

“…In this case, a small branch of pulmonary artery around the bronchus of the lingual segment left unidentified at the time of operation resulted in the injury of PA and conversion to the thoracotomy ( Figure 5). The identification rate of the branch of the pulmonary artery reportedly ranged from 95.1% to 98.7% (4,7,10). Artery with small caliber (smaller than 2 mm) tended to be unidentified, and identification rate was likely low in the branches of the right upper pulmonary artery (7).…”