ABSTRACT
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.
ABSTRACT
Modelo do estudo: Relato de caso. Importância do problema: Lobos e fissuras acessórias nos pulmões podem induzir a erros de interpretação e diagnóstico, além de favorecer a disseminação de patologias como a pneumonia para lobos adjacentes. Dessa forma, a constatação dessas alterações anatômicas pode colaborar em diagnósticos clínicos e procedimentos cirúrgicos. Comentários: Relatamos um caso raro de modificação anatômica nos lobos e fis-suras dos pulmões. O pulmão esquerdo exibia um lobo médio acessório e uma fissura horizontal completa. Por outro lado, o pulmão direito apresentava duas fissuras acessórias incompletas situadas inferiormente na face costal do lobo médio. Além disso, observamos que o hilo do pulmão esquerdo continha dois brônquios lobares (superior e inferior), um brônquio lobar acessório e três artérias pulmonares. O conhecimento das variações anatômicas aqui relatadas é fundamental, pois auxiliam os profissionais da saúde nos diagnósticos e nas decisões terapêuticas e cirúrgicas.(AU)
Study: Case Report. Importance: Lobos and accessory fissures in the lungs can induce errors of interpretation and diagnosis, as well as favor the spread of pathologies such as pneumonia to adjacent lobes. Thus, the confirmation of these anatomical alterations can collaborate in clinical diagnoses and surgical procedures. Comments: We report a rare case of anatomical variation in the lobes and fissures of the lungs. The left lung showed an accessory middle lobe and a complete horizontal fissure. On the other hand, the right lung had two incomplete accessory fissures located inferiorly in the costal face of the middle lobe. In addition, we observed that the left lung hilum contained two lobar bronchi (upper and lower), one accessory lobar bronchus and three pulmonary arteries. Knowledge of the anatomical variations reported here is fundamental, as they help health professionals in diagnoses and therapeutic and surgical decisions (AU)
Subject(s)
Humans , Male , Cadaver , Anatomic Variation , Lung/anatomy & histologyABSTRACT
The fissures of lungs are embryologically separating the bronchopulmonary segments, which later on persist in interlobar planes of fully developed lung. Fifty lungs (23 right side and 27 left side), obtained during routine dissection and preserved in formalin constituted the material for present study. In them, variations in fissures and lobes of lung were observed and compared with the previous studies. Seven right sided and 14 left sided lungs showed incomplete oblique fissure. Incomplete horizontal fissure of right lung was observed in eight lungs while it was completely missing in three specimens. A right lung with “lobe of the azygos vein” separated by a supernumerary fissure in medial surface was found. One of the right lung had both superior accessory fissure and inferior accessory fissure and four other right lungs and one left lung presented only with inferior accessory fissure. A vertical notch was found in middle lobe of one right lung. Eight left lungs exhibited with left minor fissure among them two lungs had lingula appearing as a separate lobe. Knowledge of variations in fissures and lobes is of interest to all medical professionals to exactly interpret radiographs, computed tomography scans, to diagnose, plan and modify a surgical procedure depending on the merit of the case and also in certain classical clinical cases pertaining to lung pathologies.
Subject(s)
Humans , Cadaver , Formaldehyde , Lung , PathologyABSTRACT
Background: The tracheobronchial pattern of human lungs is well known. An attempt was made to compare the pattern with that of sheep lung using luminal plastination of sheep lung. Several similarities were observed between the two patterns, due to which, the sheep lung serves as an ideal experimental model to study the effect of treatment in several human airway diseases. Objective: The first objective was to compare the two tracheobronchial patterns. Moreover the study also provided an opportunity to the authors to attempt a luminal plastination. The final objective is to highlight the various advantages of advances in luminal plastination in current medical education and research. Materials and methods: Silicon sealant was injected into the tracheobroncheal tree of sheep after thoroughly cleaning the lungs with saline. After the sealant solidified the surrounding lung tissue was destroyed by boiling. Thus a luminal cast was prepared. Result: The result was a splendid luminal cast of the sheep lung showing its tracheobronchial pattern. Conclusion: It was observed that the tracheobronchial division pattern showed significant similarities and a single variation. Therefore the sheep lung is an ideal experimental model and luminal plastination can be applied to comparative anatomical study to identify more such models.
ABSTRACT
Three-dimensional (3D) structure of the bronchopulmonary segments should be understood for accurate diagnosis and treatment of lung diseases. Two-dimensional (2D) tools (e.g. anatomy books) or traditional 3D tools (e.g. plastic models) are not sufficient for understanding 3D structure of the bronchopulmonary segments. The lung of a cadaver may not always be available for dissection, when it is needed. To overcome this problem, virtual dissection programs of the lung have been made. However, most programs include either 2D images that do not permit free dissection or radiographs that do not reveal true color and have limited resolution, and cannot represent 3D structure of the bronchopulmonary segments. Moreover, it is necessary to make a virtual dissection program of each race and ethnic group. Thus, we attempted to make a 3D image and virtual dissection program of the lung using a Korean cadaver in order to help medical students and doctors better understand 3D structure of the bronchopulmonary segments. One pair of lungs was extracted from a Korean male cadaver. Dye with specific color was injected into each segmental bronchus to distinguish bronchopulmonary segments. The lungs were embedded with gelatin solution, and serially-sectioned with 1 mm- thickness using a meat slicer. Sectioned specimens from each lung were inputted into the computer using a scanner (300 X 400 resolution, true color). 2D images of the lungs were aligned on the alignment program which was composed using IDL language. In 2D images, the bronchopulmonary segments were manually segmented by help of dye. 3D images of the bronchopulmonary segments were reconstructed through the volume-based rendering of 2D images. With 3D images as the main features, the virtual dissection program of the bronchopulmonary segments was composed using IDL language. Various virtual dissection functions, such as sectioning a lung at free angles to show its plane, identifying the bronchopulmonary segments represented in the sectioned plane, and rotating the selected bronchopulmonary segments at free angles, were established. This virtual dissection program of the bronchopulmonary segments is helpful in better understanding 3D location and shape of the bronchopulmonary segments; it is expected to be used through CD-title or Internet as an educational tool for medical students and doctors.