Variations In Branching Pattern Of Segmental Bronchi In Lungs Using Conventional Dissection Method

Introduction: The anatomical knowledge of tracheobronchial tree and its variations will be useful in case ofmany interventional treatments. Hence we undertook the present study to document the variation in branchingpattern of segmental bronchi and its clinical implication.Materials and Methods: The Study was done on 30 right & 30 left formalin fixed adult lungs obtained from thecadavers in the Department of Anatomy, Kempegowda Institute of Medical Sciences, Bangalore. The lung wasdissected along the primary bronchi to expose the branching pattern, till the segmental bronchi. Ramification ofbronchial tree was observed and photographed.Results: Regular pattern of B1 to B10 was found to be more on right side (76.6%), Absence of B7 was also more onright side. The pattern B7, B8+9+10(6.6%), was seen only on right side, whereas the patterns, B1+B2,B3, B7+8,B9+10,B7,B8,B9+10 and B7+8, B9,B10 was seen only in the left lungs. Two left lungs exhibited an accessory bronchusafter lingual division and three left lungs had three bronchi in lingual division.Conclusions: The knowledge of anatomical variability of branching pattern will be useful for interventionalradiologist, which would help to diagnose or predict many adverse outcomes of chest diseases at earlier stageand surgeons for planning segmental resections or pulmonary lobectomy.

Bronquio cardíaco accesorio y otras variantes de la anatomía tráqueo-bronquial / Accessory cardiac bronchus and others variations of the tracheobronchial anatomy

Entre las variantes de la anatomía bronquial nos podemos encontrar con ramas bronquiales displásicas, ramas ausentes o ramas supernumerarias. Aunque gran parte son asintomáticas, es esencial reconocerlas porque se pueden asociar a hemoptisis, infecciones recurrentes, empiema o a complicaciones secundarias a procedimientos (por ejemplo intubaciones endotraqueales, fibrobroncoscopías, lavado broncoalveolar, biopsias, tratamientos endobronquiales, instalación de stent, braquiterapia y cirugías pulmonares entre otros). En este articulo describimos las variantes bronquiales más prevalentes en tomografia computada, incluyendo al bronquio cardíaco accesorio, bronquio traqueal y bronquio puente, entre otras.

Among the variations of bronchial anatomy, we can find dysplastic bronchial branches, an absence of bronchial branches, or supernumerary branches. Although many of them are asymptomatic, it is essential to know them because they may be associated with hemoptysis, recurrent infections, empyema, or complications secondary to various procedures (e.g. endotracheal intubation, brochoscopy, bronchoalveolar lavage, biopsy, endobronchial treatments, stent installation, brachytherapy and lung surgeries among others). In this study we used computed tomography to describe some of the most prevalent bronchial variations, including accessory cardiac bronchus, tracheal bronchus, and bridge bronchus among others.

A Case of Primary Endobronchial Actinomycosis Presenting as a Complicated Parapneumonic Effusion

Endobronchial actinomycosis is a rare but important and challenging diagnosis to make. We report a case of 57 year-old man who presented with a fever and a right-sided chest pain diagnosed as an endobronchial actinomycosis. Chest computed tomography showed a segmental obstruction and consolidations in right middle lobe combined with an ipsilateral multiloculated pleural effusion. Bronchoscopic biopsy of a mass obstructing the medial segmental bronchus of right middle lobe revealed actinomycosis. This is the first reported case of primary endobronchial actinomycosis that presented with a chest pain and a complicated parapneumonic effusion. Primary endobronchial actinomycosis can be a cause of complicated parapneumonic effusion.

The diagnostic value of CT bronchial sign in peripheral solitary pulmonary lesions / 中华放射学杂志

Objective To investigate the differential diagnostic values of CT bronchial sign for peripheral solitary pulmonary lesions(SPLs).Methods One hundred and eleven patients with peripheral SPLs were scanned using multi-slice helical CT(MSCT),and multiplanar reconstruction was performed to show the relationship between the lesion and bronchus,the diffefences between the benign and malignancy were compared by using chi-square test.Results Bronchial cutoff rate in malignant lesions(47/95,49.5%)was markedly hi er than that in benign lesions(10/42,23.8%.X12=7.896,P＜0.05),the frequency of type Ⅰ and type Ⅱ air bronchogram presented in malignant lesions(10/11.8/9)was higher than benign lesions(1/11,1/9.X2=6.975,4.818,P＜0.05),but type Ⅳ in benign lesions(12/17)was more common than that in malignant lesions(5/17.X2=7.390,P＜0.05).No significant difference was found in bronchus ran at the periphery of the lesion and bronchus dragged by the lesion between benign(9/24.1/4)and malignant lesions(15/24,3/4.X2=0.641,0.062,P＞0.05).The focal bronchial wall thickening in malignancy(21/22)was markedly higher than benign lesions(1/22.X2=4.185.P＜0.05),whereas the extensive thickening in benign lesiom(4/7)was more common(3/7.X2=8.650,P＜0.05).Conclusion CT bronchial sign is very important in the differentiation of benign and malignant pulmonary lesions.

Reconstruction of Mainstem Bronchus Obstructed by Endobronchial Tuberculosis / 대한흉부외과학회지

BACKGROUND: Non-invasive interventional therapy has been performed for main bronchial obstruction by endobronchial tuberculosis because of the risk of main bronchial reconstruction regardless of the pulmonary function. But, effects of the interventional therapy are attacked by arguments. This study was aimed at interpreting the risk and effectiveness of bronchoplasty for benign bronchial stenosis over the last ten years in our hospital by reviewing the results based on clinical progression. MATERIAL AND METHOD: We retrospectively reviewed the clinical records and out-patient medical records including 21 consecutive patients who underwent main bronchial reconstruction for obstruction by endobronchial tuberculosis. All of them had past medical history of anti-tuberculosis medication. They were preoperatively evaluated by bronchoscopy and chest computed tomography. RESULT: There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions but these problems were resolved by therapeutic bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. CONCLUSION: Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

Bronchoesophageal Fistula Complicated by Broncholithiasis in a Patient with Silicosis: 1 case / 대한흉부외과학회지

Broncholithiasis is uncommon in patients with silicosis. Bronchoesophageal fistula complicated by broncholithiasis is especially rare and only one case has been reported in Korea. Surgical treatment of broncholithiasis should be as conservative as possible to preserve the adequate pulmonary function. Meticulous dissection and division of the fistula with the interposition of viable tissues will prevent recurrence. We report a rare case of bronchoesophageal fistula complicated by broncholithiasis in a patient with silicosis.

Clinical Analysis of Bronchogenic Cyst / 대한흉부외과학회지

BACKGROUND: Bronchogenic cyst is a rare and benign disease. Because of its complication or associated disease, Bronchogenic cyst requires surgical treatment. Recently, with the development of diagnostic methods, its incidence has increased. So we reviewed our results from the past 30 years. MATERIAL AND METHOD: We reviewed 27 cases surgically treated from March 1971 to March 2003. This investigation is designed to illustrate the peak age incidence, sex ratio, symptoms, anatomic location, radiologic imagings, associated diseases, operative methods, postoperative pathologic findings and postoperative complications. RESULT: The peak age incidence laid in the 1st to 3rd decade and the ratio of male and female was 1:1.5. The most common complaints were cough and dyspnea, but some had hemoptysis. There were 22 cases (81%) of Intrapulmonary bronchogenic cysts and 5 cases(19%) of mediastinal bronchogenic cysts. Thirteen cases (48.1%) showed cystic lesion in simple chest X-ray. Ten cases showed cystic lesion among 13 cases that had taken computed tomography. We found associated disease in 15cases (56%). The inflammatory diseases from infection were many in intrapulmonary bronchogenic cysts and especially, one case showed carcinosarcoma. Mitral regurgitation and Bronchial obstruction could be seen in mediastinal bronchogenic cysts. The 13 cases (48%) were managed by lobectomy, and cystectomy, pneumonectomy, and segemental resection were done in 7 cases (26%), 4 cases (15%), 3 cases (11%) respectively. Cystic contents were mucus in 9 cases, pus in 9 cases, blood in 2 cases, and carcinosarcoma in 1 case. Bronchotracheal communications were in 13 cases (48%). Five cases showed Postoperative complications, which were pneumothorax, empyema, bleeding. Postoperative death could not be found. CONCLUSION: Almost all patients had clinical symptoms. Severe complications could be associated with bronchogenic cysts. Recently, With the development of diagnostic methods, preoperatively accurate diagnosis is possible; therefore, invasive study has decreased. Bronchogenic cyst is a benign disease. However, because of its clinical symptoms, complications, and possibility of malignant change, immediate surgical treatment is needed.

Congenital Bronchial Atresia / 결핵

Congenital bronchial atresia is a rare anomaly, which results from a congenital focal obliteration of a proximal segmental or subsegmental bronchus, with normal development of the distal structures. The short atretic segment leads to the accumulation of mucus within the distal bronchi, forming a bronchocele and air trapping of the alveoli supplied by these bronchi. The diagnostic CT features include the presence of a branching opacity and the bronchocele, which radiate from the hilum and are surrounded by an area of hyperlucency.

Bronchial Atresia with Collapse of the Right Upper Lobe: A Case Report / 대한흉부외과학회지

Congenital bronchial atresia is one of the rare bronchopulmonary anomalies which is thought to be caused by a vascular insult of uncertain timing during fefal development. It is defined as an anomaly which does not have communication between a segmental or lobar bronchus and the main airway. Because of the collateral ventilation, almost all of these cases show hyperlucency of the involved segment or lobe in chest roentgenogram. We report an extremely rare case of congenital bronchial atresia with collapse of the right upper lobe which was treated by surgical resection.