Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Estudio morfométrico de los bronquios principales y del bronquio intermedio en una muestra cadavérica colombiana / Morphometric study of the main bronchi and the intermediate bronchus in a Colombian cadaveric sample

Conocer la morfometría en longitud, circunferencia y angulación de los bronquios principales y del bronquio intermedio pueden ser datos relevantes en procedimientos radiológicos, quirúrgicos e inclusive en eventos que amenazan la vida como la broncoaspiración. Existe poca evidencia acerca de la morfometría de los bronquios principales y del bronquio intermedio, es por ello que el presente estudio tuvo como objetivo describir la morfometría de los bronquios principales y del bronquio intermedio en una muestra de población cadavérica colombiana. Se realizó un estudio descriptivo donde se seleccionaron 29 especímenes de Cali, Colombia; 11 correspondieron a cadáveres y 18 a órganos aislados del tracto respiratorio inferior; se incluyeron los cadáveres con las estructuras debidamente disecadas y se excluyeron las muestras con estructuras anatómicas ausentes o dañadas y que afectaran la realización de las mediciones. La media de longitud del bronquio principal derecho fue de 1,69 cm IC 95 % (1,51 - 1,87) la media de la longitud del bronquio intermedio fue de IC 95 % 2,89 cm (2,66 - 3,12), la media de longitud del bronquio principal izquierdo fue de 3,34 cm IC 95 % (3,01 - 3,68); el ángulo interbronquial tiene una media de 80,17º IC 95 % (72,87 - 87,48). Las mediciones del bronquio principal derecho concuerdan con las reportadas en la literatura, lo contrario ocurre con el bronquio principal izquierdo; la medición del ángulo interbronquial muestra diferencias a la reportada por la literatura. Este estudio muestra que a pesar de que existen nomenclaturas y consensos internacionales, estos no han sido implementados correctamente por los profesionales de la salud y el término de bronquio intermedio es utilizado en la práctica diaria, por lo que se hace necesario que las Sociedades de Anatomía y Morfología vuelvan a discutir su importancia y reconocimiento en la nomenclatura.

Knowing morphometry in length, circumference and angulation of the main bronchi and the intermediate bronchus can be relevant data in radiological, surgical procedures and even in life-threatening events such as bronchoaspiration. Evidence is scarce about the morphometry of the main bronchi and the intermediate bronchus, that is why the present study aimed to describe the morphometry of the main bronchi and the intermediate bronchus in a Colombian cadaveric population sample. A descriptive study was carried out where 29 specimens were selected from Cali, Colombia; 11 corresponded to cadavers and 18 to organs isolated from the lower respiratory tract; cadavers with duly dissected structures were included and samples with anatomical structures that were absent or damaged, and that affected the performance of the measurements were excluded. Descriptive statistics was used to analyze the data. The mean length of the right main bronchus was 1.69 cm 95 % CI (1.51-1.87), the mean length of the intermediate bronchus was 2.89 cm 95 % CI (2,663,12), the mean length of the left main bronchus was 3.34 cm 95 % CI (3-3.68); the interbronchial angle had an average of 80.17º 95 % CI (72.87-87.48). The measurements of the right main bronchus agree with those reported in the literature, the opposite occurs with the left main bronchus; interbronchial angle measurement showed differences to that reported by the literature. This study shows that although there are international nomenclatures and consensus, these have not been implemented correctly by health professionals and the term intermediate bronchus is used in daily practice, it is therefore necessary that the Societies of Anatomy and Morphology again discuss their importance and recognition in the nomenclature.

Ventilación colateral: una propuesta para terminologia histologica / Collateral ventilation: a terminologia histologica proposal

La correcta utilización de los términos morfológicos está estandarizada por las terminologías, una de ellas es la Terminologia Histologica (TH). Éstas sugieren la exclusión de los epónimos. Pese a esto, existen estructuras que continúan en esta condición. Específicamente, "Poros de Kohn, Canales de Martin y Canales de Lambert" son términos que componen la ventilación colateral (VC) y son ejemplo de esta situación. Así, el objetivo del presente estudio fue identificar en TH los términos asociados a la VC a fin de proponer denominaciones siguiendo las recomendaciones de la Federación Internacional de Programas de Terminologías Anatómicas (FIPAT). Se buscaron los términos relacionados a la VC en TH, posteriormente, se efectuó el mismo ejercicio en textos de histología, además de esto, en base de datos MedLine a través de su buscador PudMed con el siguiente algoritmo: (lung) AND (alveoli pulmonary) AND (airway) AND (collateral) AND (ventilation). En TH se encontró el término Porus septalis (H3. 05.02.0.00036) para referirse al término Poros de Kohn, en seis textos de histología se menciona el término Poros de Kohn, en 21 artículos revisados se menciona la VC, de estos, en diez se utiliza el epónimo Poro de Kohn, para referirse a los poros septales, el epónimo Canales de Lambert fue utilizado en seis artículos y el epónimo Canales de Martin, apareció en cinco artículos. A partir de la información encontrada, su desarrollo histórico, sumado a los lineamientos de la FIPAT, proponemos complementar e incluir en TH los términos Porus septalis alveolaris para los poros de Kohn, Ductus bronchiolaris alveolaris para los Canales de Lambert y Ductus interbronquiolaris para los canales de Martin, respectivamente.

The correct use of morphological terms is standardized by the Terminologies, one of them is the Histological Terminology (HT) For these Terminologies, the exclusion of eponyms is recommended. Despite this, there are structures that remain as eponyms. Three in particular: Pores of Kohn, Martin Channels and Lambert Channels are terms that make up collateral ventilation (CV) and are an example of this. Thus, the objective of the present study was to identify in the HT the terms associated with the CV in order to propose denominations following the recommendations of the Federative International Programme on Anatomical Terminologies (FIPAT). The terms related to CV in the TH were researched, and subsequently, the same exercise was carried out in histology texts. The MedLine database was also used through its PudMed search engine with the following algorithm: (lung) AND (alveoli pulmonary) AND (airway) AND (collateral) AND (ventilation). In HT the term Porus Septalis" (H3.05.0.0.036) was found to refer to the term "Pores of Kohn, in six histology texts the term Pores of Kohn is mentioned, in 21 reviewed articles the CV is mentioned, of these, in ten the eponymous Pores of Kohn is used, to refer to the Septal Pores, the eponymous Lambert Channels was used in six articles and the eponymous Martin Channels appeared in five articles. From the information found, its historical development, added to the guidelines of the FIPAT, we propose complementing and including in the HT the terms "Porus septalis alveolaris" for pores of Kohn, "Ductus bronchiolaris alveolaris" for the Lambert Channels and "Ductus interbronquiolaris" for the Martin Channels, respectively.

Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study / Fatores de risco para hipoxemia intraoperatória durante ventilação monopulmonar: estudo observacional

Abstract Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. Methods We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. Result Patients with a left main bronchus length of less than 40 mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). Conclusions We identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.

Resumo Justificativa Os tubos endotraqueais de duplo lúmen (Double-lumen tubes - DLTs) para intubação seletiva esquerda têm sido amplamente utilizados em procedimentos torácicos, esofágicos, vasculares e mediastinais para proporcionar a separação dos pulmões. Com a falta de diretrizes claras, os anestesiologistas geralmente selecionam os tubos com base em sua experiência com os tubos endotraqueais de duplo lúmen de 35 e 37 Fr, os mais comumente usados. Nossa hipótese foi que os pacientes com um brônquio principal esquerdo de menor comprimento (< 40 mm) apresentavam uma chance maior de sofrer dessaturação durante a ventilação monopulmonar, devido à obstrução do orifício do lobo superior esquerdo com o tubo brônquico. Métodos No total, 360 pacientes submetidos à intubação seletiva esquerda mediante o uso de tubo de duplo lúmen foram incluídos no estudo entre setembro de 2014 e agosto de 2015. Idade, sexo, altura, peso e doença de base foram registrados, junto do tipo de procedimento cirúrgico e os episódios de dessaturação. Além disso, a largura da traqueia e a largura e comprimento do brônquio esquerdo foram medidos por meio de tomografia computadorizada. Resultados Os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm, submetidos à intubação seletiva esquerda com tubos endotraqueais de duplo lúmen, tiveram incidência significativamente maior de dessaturação (Odds Ratio - OR: 8,087) durante a ventilação monopulmonar. Outros fatores relacionados aos pacientes e identificados como risco de desenvolver hipoxemia foram diabetes mellitus (OR: 5,368), cirurgia de colapso direito (OR: 4,933) e IMC (OR: 1,105). Conclusões Identificamos que os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm apresentam grande chance de dessaturação, principalmente se outros fatores de risco para dessaturação estiverem presentes.

Primera caracterización del árbol bronquial derecho en Cuba con el uso de la broncoscopia / First characterization of the right bronchial tree in Cuba by bronchoscopy

Introducción: El alcance de la maestría en el estudio endoscópico de las vías aéreas debe basarse en un conocimiento de la anatomía bronquial, sus divisiones, nomenclatura y los hallazgos endobronquiales normales. Objetivo: Caracterizar la anatomía del árbol bronquial derecho mediante broncoscopia flexible diagnóstica. Métodos: Se realizó un estudio descriptivo, de corte transversal prospectivo, en 2000 pacientes, en un periodo de 12 años, a los que se les realizó una revisión completa de las variantes del árbol bronquial derecho. Resultados: En el bronquio lobar superior la división más frecuente fue la bifurcación con 58,4 por ciento, el bronquio lobar medio siempre se bifurcó. En el segmento B6 predominó la bifurcación 87,7 por ciento y la más frecuente fue el tipo B6 y B6 b+c. El resto de los basales se comportaron de la manera siguiente: el segmento paracardiaco no apareció en un 8,15 por ciento, predominó la bifurcación con 89,15 por ciento y de estas, la división B8 y B9 + B10. En cuanto a las malformaciones congénitas estuvieron presentes 0,65 por ciento de bronquio traqueal, 0,15 por ciento de bronquio cardiaco accesorio y 5,15 por ciento de bronquio subsuperior. Conclusiones: El árbol bronquial derecho en la población cubana tiene características propias(AU)

Introduction: The skill scope in the airways endoscopic study should be based on the bronchial anatomy knowledge, its divisions, nomenclature and the normal endobronchial findings. Objective: To characterize the anatomy of the right bronchial tree using diagnostic flexible bronchoscopy. Methods: A descriptive, prospective cross-sectional study was carried out in 2000 patients, over a period of 12 years. A complete review of the right bronchial tree these variants was performed on these patients. Results: The most frequent division was the bifurcation with 58.4%, in the upper lobar bronchus. The middle lobar bronchus always bifurcated. In segment B6, bifurcation predominated (87.7percent), and the most frequent was type B6 and B6 b + c. The rest of the basals behaved as follows: the paracardiac segment did not appear in 8.15 percent, bifurcation predominated (89.15 percent) and out of these, B8 and B9 + B10 division. Regarding congenital malformations, we found 0.65 percent tracheal bronchus, 0.15 percent accessory cardiac bronchus and 5.15 percent subsurface bronchus. Conclusions: The right bronchial tree in the Cuban population has its own characteristics(AU)

Morfologia da traqueia e lobação pulmonar de Leopardus pardalis (jaguatirica) / Morphology of the trachea and lung lobation of Leopardus pardalis (ocelot)

A espécie Leopardus pardalis, conhecida popularmente como jaguatirica, é um felino de médio porte com ampla distribuição em território nacional e está incluída na lista de espécies da fauna brasileira ameaçadas de extinção. Este estudo teve como objetivo caracterizar os aspectos macroscópicos e microscópico da traqueia e lobos pulmonares em L. pardalis. As análises foram feitas utilizando cinco exemplares de jaguatirica, sendo dois machos e três fêmeas, adultos, três desses exemplares foram a óbito por atropelamento em rodovias próximas ao município de Alta Floresta, e dois doados após a morte pelo IBAMA ao o Laboratório de Zoologia e Morfologia Animal. Nos espécimes a traqueia era um tubo flexível formado por pares de arcos cartilaginosos, apresentando epitélio pseudo-estratificado não ciliado no seu revestimento interno, e outros estruturas básicas deste órgão. O pulmão se mostrou como um órgão constituído por lobos separados por fissuras com um parênquima usual aos demais mamíferos descritos. No que diz respeito às caraterísticas anatômicas da traqueia e pulmão se mostraram semelhantes à de outros mamíferos, já nos aspectos microscópicos da traqueia apresentou certas peculiaridades diferindo dos demais trabalhos encontrados. No que tange o aspecto do parênquima pulmonar as características histológicas não variaram com as que estão descritas.(AU)

The species Leopardus pardalis, popularly known as ocelot, is a medium sized cat with wide distribution in the national territory and is included in the list of species of Brazilian fauna threatened with extinction. This study aimed to characterize the macroscopic and microscopic aspects of the trachea and lung lobes in L. pardalis. Analyses were performed using five copies of ocelot, two males and three females, adults, three of these specimens died from being run over on highways nearby the municipality of Alta Floresta, and two donated after death by IBAMA to the Laboratory of Zoology and Animal Morphology. In the trachea specimens was a flexible tube formed by pairs of cartilaginous arches, with pseudo-stratified epithelium ciliated not in its inner lining, and other basic structures of this body. Lung proved as a body made up of lobes separated by cracks with a usual parenchyma to the other described mammals. With respect to the anatomic features of the trachea and lung were similar to other mammals, as in the microscopic aspects of the trachea showed certain peculiarities found differing from the other jobs. Regarding the appearance of the lung parenchyma histological characteristics did not differ with those described.(AU)

Anatomia e segmentação pulmonar de tamanduá-bandeira (Myrmecophaga tridactyla - Linnaeus, 1758) de vida livre / Anatomy and pulmonary segmentation of Free-living Giant Anteater (Myrmecophaga tridactyla - Linnaeus, 1758)

O presente trabalho utilizou oito pulmões de tamanduá-bandeira (Myrmecophaga tridactyla), jovens e adultos, de ambos os sexos, provenientes do Setor de Atendimento Clínico Cirúrgico de Animais Selvagens (SACCAS), do Hospital Veterinário "Dr. Halim Atique"( Unirp, localizado na cidade de São José do Rio Preto, estado de São Paulo. Os animais foram encaminhados ao Laboratório de Anatomia Veterinária, onde se procedeu à separação dos órgãos, à lavagem em água corrente e à retirada do excesso de sangue, para serem fixados em formol a 10%. Após a fixação dos pulmões, estes foram dissecados para identificar os segmentos. Os animais apresentaram lobação pulmonar à direita em cranial, médio, caudal e acessório, sendo o lobo cranial dividido em partes cranial e caudal. A lobação pulmonar à esquerda apresentou cranial e caudal em 100% dos animais. Por sua vez, o lobo cranial, em 87,5%, dividiu-se em partes cranial e caudal, e em 12,5% não houve divisão. O pulmão direito apresentou maior tamanho do que o pulmão esquerdo. A árvore brônquica apresentou os brônquios principais direito e esquerdo, os quais se ramificam em brônquios lobares, que dão origem aos segmentos bronquiopulmonares. Em relação à segmentação bronquiopulmonar, foram observadas, à direita, de 14 (12,5%) a 18 segmentos (25%) e, à esquerda, de 10 (25%) a 30 segmentos (12,5%).(AU)

The study used eight lungs of giant anteaters (Myrmecophaga tridactyla), youth and adults of both sexes, from the Clinical Surgical Care Industry Wildlife (SACCAS), Veterinary Hospital "Dr. Halim Atique "- Unirp, located in the city of São José do Rio Preto, São Paulo. The animals were sent to the Veterinary Anatomy Laboratory, where organs were separated and washed under running waterto remove excess blood, then fixed in 10% formalin. After fixation, lungs were dissected to identify the segments. The animals have pulmonary lobations right cranial, middle, caudal and accessory; and the cranial lobe divided into cranial and caudal parts. Pulmonary lobation in the left cranial and caudal form were present in 100% of animals. The cranial lobe was evident in 87.5%, divided into cranial and caudal part, and 12.5% with no division. The right lung was shown to be larger than the left lung. Bronchial tree presented the main right and left bronchial tubes that branch into lobar bronchi that give rise to bronquiopulmonares segments. In relation to bronquiopulmonar targeting, 14 (12.5%) to 18 right segments (25%) and 10 (25%) to 30 (12.5%) left segments.(AU)

Morfo-histologia dos pulmões e árvore bronquial de Procyon cancrivorus (Carnivora: Procyonidae) / Morphohistology of the lungs and bronchial tree of the Procyon cancrivorus (Carnivora: Procyonidae)

Nenhuma característica dos seres vivos é tão primordial quanto a respiração, e os pulmões são os principais órgãos do sistema respiratório. Este estudo tem por objetivo descrever os aspectos macroscópicos da traqueia, dos brônquios e dos lobos pulmonares bem como os aspectos microscópicos dos brônquios pulmonares do mão-pelada e compará-los com dados da literatura de estudos realizados com mamíferos silvestres e domésticos. Utilizaram-se três exemplares de Procyon cancrivorus, que foram fixados em solução aquosa de formaldeído a 10%. Os pulmões e a traqueia foram dissecados e fotografados com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Para a identificação das características microscópicas, foram coletados fragmentos de cada brônquio seguindo as técnicas de rotina histológica. O pulmão do Procyon cancrivorus se divide em quatro lobos direito e dois lobos esquerdo e a traqueia apresenta cerca de 31 a 34 anéis. Os brônquios extrapulmonares se dividem em direito e esquerdo; o direito se subdivide em brônquios lobares cranial, médio, acessório e caudal, e o esquerdo em lobares cranial e caudal, com seus respectivos brônquios segmentares. Microscopicamente, os brônquios apresentam um epitélio prismático pseudoestratificado ciliado com células caliciformes e feixes de fibras de musculatura lisa, placas de cartilagem hialina e fibras elásticas. O conhecimento da morfologia desses órgãos nas espécies silvestres auxilia em estudos descritivos e/ou comparativos entre espécies.

No characteristic of living beings is as primal as breathing, and the lungs are the main organs in the respiratory system. This study aims to describe the macroscopic aspects of the trachea, bronchus and lung lobes and microscopic aspects of the bronchi of raccoon lungs and compare with data from the literature studies performed with wild and domestic mammals. We used three samples of Procyon cancrivorus, which were fixed in aqueous 10% formaldehyde, lungs and trachea were dissected and photographed with a digital camera (Sony a200 Camera, 10.2mpx). For the identification of microscopic characteristics, fragments were collected from each bronchus following routine histological techniques. The Procyon cancrivorus lung is divided into four lobes, with two right and left lobes. The trachea has about 31-34 rings. The extrapulmonary bronchi divides into left and right, where the right is divided into lobar bronchi cranial, middle, accessory and caudal lobes and the left in cranial and caudal, with their respective segmental bronchi. Microscopically the bronchial epithelium has prismatic pseudo-ciliated and goblet cells with bundles of smooth muscle fibers, plates of hyaline cartilage and elastic fibers. Knowledge of the morphology of these organs in wild species helps us in descriptive studies and / or comparisons between species.

Pared membranosa de los bronquios: propuesta de inclusión en la terminología anatómica / Membranous wall bronchus: proposal for inclusion in the terminologia anatomica

Los bronquios principales son dos tubos respiratorios que se originan de la parte inferior de la tráquea y se proyectan a cada pulmón, permitiendo el paso de aire hacia y desde los bronquíolos. El objetivo de este trabajo fue verificar la inclusión como término morfológico de la pared posterior de los bronquios principales en la Terminologia Anatomica y en los textos de enseñanza de la anatomía macroscópica. Se revisó la Terminologia Anatomica y se comparó con diversos textos y artículos de enseñanza de la anatomía macroscópica, con el fin de verificar si hay descripciones de la pared posterior de los bronquios principales y si ésta se encuentra nominada. No está incluido en la Terminologia Anatomica ningún término para nominar la pared posterior de los bronquios principales, por lo que se propone incluir el término pared membranosa para tales bronquios en la Terminologia Anatomica.

There are two main bronchi breathing tubes originating from the bottom of the trachea and lung projecting to each, allowing passage of air toward and from the bronchioles. The objective of this work was to verify the morphological term inclusion as the back wall of the main bronchus in Anatomic Terminology and texts for teaching gross anatomy. Terminologia Anatomica was analyzed and compared with various texts and journals of gross anatomy teaching, in order to verify if there are descriptions of the posterior wall of the main bronchi and whether it has been nominated. In the Terminologia Anatomica the term for the back wall of the main bronchus is not included. Therefore, it is proposed that the term "membranous wall" for bronchus be included in Terminologia Anatomica.

Distribuição dos brônquios lobares dos pulmões do veado-catingueiro Mazama gouazoubira / Distribution of lobar bronchi of the lungs of brown brocket deer Mazama gouazoubira

Este estudo teve como objetivo descrever a lobação do pulmão do veado-catingueiro Mazama gouazoubira. Dois animais da espécie, obtidos post mortem por atropelamento em rodovia, foram utilizados para o estudo, obedecendo aos critérios da Lei Vigente (Lei 1.153/95). Através da dissecação, a pele foi completamente removida e os animais foram fixados em solução de formaldeído a 10 porcento. Através de um acesso ventral, o bloco de vísceras foi removido e posteriormente os pulmões foram dissecados do bloco por uma secção na região torácica da traqueia e de outras estruturas do hilo pulmonar. Os pulmões e a árvore brônquica foram dissecados, fotografados, as imagens foram registradas com câmera fotográfica digital (Câmera Sony a200, 10.2mpx). Os pulmõesapresentaram-se unidos pelas estruturas que penetravam a região do hilo pulmonar, o pulmão direito do veado-catingueiro mostrou ser composto pelos lobos cranial (segmento cranial e segmento caudal), médio, caudal e acessório. O pulmão esquerdo apresentou apenas lobo cranial (segmentado em parte cranial e parte caudal) e lobo caudal. A árvore brônquica se inicia emergindo para o pulmão direito um brônquio traqueal acima da bifurcação da traqueia que sequencialmente serão denominados de brônquios principais direito e esquerdo, os quais no nível do hilo pulmonar penetram nos pulmões direito e esquerdo respectivamente. Os pulmões e árvore brônquica de M. gouazoubira apresentaram a mesma descrição anatômica de outros ruminantes, como bubalinos, ovinos e bovinos.

The study aimed to describe the lung lobation of the brown brocket deer, Mazama gouazoubira. Two animal of the species, obtained postmortem by trampling on the highway, were used for the study, according to criteria of the Governing Law (1.153/95). The skin was completely removed and the animals were fixed in 10 percent formaldehyde. The viscera were removed and the lungs were dissected by a section of the block in the thoracic trachea and other structures of the pulmonary hilum. The lungs and bronchial tree were dissected, photographed and the images were recorded with a digital camera (Sony a200 Camera, 10.2mpx). The lungs showed themselves united by structures that penetrate the region of the pulmonary hilum, the right lung was found to be composed of the cranial lobes (segment cranial and caudal segment), middle, caudal and accessory. The left lung showed only cranial lobe (segmented into the cranial and caudal part) and caudal lobe. The bronchial tree begins emerges to the right lung one tracheal bronchus above the bifurcation of the trachea that are sequentially named right and left main bronchi, which at the level of the pulmonary hilum penetrate the left and right lungs respectively. The lungs and bronchial tree of M. gouazoubira showed the same anatomical description of other ruminants, like buffaloes, sheep and cattle.

Bronchial tree architecture in mammals of diverse body mass / Arquitectura del árbol bronquial en mamíferos de diferentes masas corporales

The anatomy of mammal's lung air space constitutes the bronchial tree which disposition is associated to air flux dynamics. Casts obtained from human, pig and rat lungs were studied to analyze possible differences of the bronchial tree architecture in mammals with diverse dimensions and posture. Air spaces were filled with polymers through trachea followed by acid corrosion. Tracheal and main bronchial division's diameters were measured to relate with body mass using allometry. The results revealed a dichotomic bronchial branching pattern in the human casts and a monopodial pattern in animals. In allometric relationship trachea was larger in rats, then pigs and lastly in humans, differences were statistically significant, the same occurs in right bronchus, as in the left bronchus there was no difference between rat and pig. The linear relationship between the human tracheal diameters was 1.2 times larger than the pig and 6.7 times larger than the rat; the pig tracheal diameter was 5.6 times larger than the rat. Quadruped position of the pig and rat is linked to a horizontal air way while the erect position, biped in human, correspond to a vertical air way. A big mammal shows less respiratory frequency than small mammals. Mammals with small, medium and high body mass allied to diverse posture and habits was compared revealing morphological differences in the bronchial trees as different allometric correlations between quadruped animals and human biped.

La anatomía de los espacios aéreos en los pulmones de mamíferos constituyen el árbol bronquial cuya disposición es asociada a la dinámica del flujo aéreo. Moldes obtenidos de los pulmones de humanos, cerdos y ratones fueron estudiados para analizar las posibles diferencias de las arquitecturas de los árboles bronquiales en mamíferos de diferentes dimensiones y posturas. Los espacios aéreos fueran llenados con polímeros por la tráquea y posterior corrosión con ácido. Los diámetros de la tráquea y de las principales divisiones de los bronquios fueron medidos y relacionados con las masas corporales por medio de alometría. Los resultados revelaron uno patrón dicotómico en los moldes de humanos y un patrón monopodial en los animales. La relación alométrica determinço que la tráquea es mayor en los ratones, seguidos de los cerdos y por último en los humanos, las diferencias fueran estadísticamente significativas. Lo mismo ocurrió en el bronquio derecho en cambio en el bronquio izquierdo no hubo diferencia entre el cerdo y el ratón. La relación linear entre los diámetros de la tráquea fue 1,2 mayor en el humano comparada con el cerdo y 6,7 mayor que el ratón, el diámetro de la tráquea del cerdo fue 5,6 mayor que el ratón. La posición cuadrúpede del cerdo y del ratón es vinculada a una vía aérea horizontal en cuanto a que la posición erecta en humanos corresponde a una vía aérea vertical. Los grandes mamíferos muestran menor frecuencia respiratoria que los pequeños mamíferos. Mamíferos con masas corporales pequeñas, medias y grandes con diversas posturas y hábitos fueron comparados mostrando diferencias morfológicas en los árboles bronquiales así como diferentes correlaciones alométricas entre animales cuadrúpedos y humanos bípedos.

Variantes anatómicas de la segmentación bronquial, prevalencia y diagnóstico mediante TC multidetector 64 canales / Bronchial segmentation: anatomical variants, prevalence, and diagnosis by 64-channel multidetector CT

Purpose. A) To determine types and prevalence of anatomical variants of bronchial segmentation in patients who underwent 64-section Multidetector CT (MDCT) of the chest. B) To evaluate the ability of this method as a diagnostic tool. Material and methods. We conducted a retrospective review of chest computed tomography studies of 156 adult patients, performed with Toshiba, Aquilion 64 CFX, CT Scanner Equipment, with chest volumetric acquisitions, and cuts of 0.5 mm. Images obtained allowed MPR and 3D reconstructions, along with virtual endoscopic visualization of the tracheobronchial tree, in the study period from may 2007 to may 2011, irrespective of reasons to request those examinations. Results. Eighty-nine (57 percent) of the 156 cases corresponded to male patients and 67 (43 percent) to female.patients. Fifty-two variants were found in 47 patients, since in five of them two variants were observed. The most commonly encountered variants were: variant of number (28 variants, 53 percent), of which 15 (28 percent) showed sub-superior lobar bronchus, 6 (11 percent) accessory bronchus in the left lower lobe; 5 (10 percent) isomerism of lower lobes, and 2 (4 percent) accessory bronchus in the right upper lobe. Among variations of origin (24 variants, 47 percent) we found 17 variants (33 percent) with right upper lobe bifurcation; 6 (12 percent) exhibited trifurcation of the left upper lobe bronchus, and 1 (2 percent) showed accessory tracheal bronchus. Conclusion. Anatomical variants in the tracheobronchial tree exhibited a prevalence of 33 percent in our study population. We found 52 variants in 47 patients, the most common being bifurcation of the right upper lobe bronchus, and subsuperior lobar bronchus. The study of anatomical variants, along with total anatomy of the tracheobronchial tree by 64 MDCT, irrespective of study protocol applied, can provide useful information prior to performing more invasive procedures, such as conventional bronchoscopy.

Propósito. Conocer tipos y prevalencia de las variantes anatómicas de la segmentación bronquial, en pacientes a quienes se les realizó TC de Tórax Multidetector 64 (TCMD 64). Evaluar la capacidad de este método para el diagnóstico de las mismas. Material y métodos. Se estudiaron en forma retrospectiva los estudios tomográficos que incluyeron el tórax, en 156 pacientes adultos, con tomógrafo Toshiba Aquilion 64, con adquisiciones volumétricas del tórax, cortes de 0.5 mm, obteniendo imágenes que permitieron reconstrucciones MPR, 3D y visualización endoscópica virtual traqueobronquial, en el período entre mayo de 2007 y mayo de 2011, independientemente del motivo por el cual fueron solicitados. Resultados. De los 156 estudios examinados, 89 (57 por ciento) fueron de sexo masculino y 67 (43 por ciento) femenino. En su análisis se encontraron 52 variantes, en 47 pacientes, ya que en cinco de ellos se observaron dos variantes. Entre las más frecuentes fueron: de número (28 variantes-53 por ciento), de las cuales: 15 (28 por ciento) con bronquio sub-superior; 6 (11 por ciento) bronquio accesorio en lóbulo inferior izquierdo; 5 (10 por ciento) isomerismo de lóbulos inferiores; y 2 (4 por ciento) bronquio accesorio en lóbulo superior derecho. Entre las variantes de origen (24 variantes-47 por ciento) encontramos 17 variantes (33 por ciento) con bifurcación del lóbulo superior derecho; 6 (12 por ciento) trifurcación del bronquio del lóbulo superior izquierdo; y 1 (2 por ciento) bronquio traqueal accesorio. Conclusión. Las variantes anatómicas en el árbol traqueobronquial presentaron una prevalencia en nuestra población de estudio del 33 por ciento, hallándose 52 en 47 pacientes, siendo las más frecuentes la bifurcación del lóbulo superior derecho y el bronquio subsuperior. Su estudio y el de la anatomía total del árbol traqueo-bronquial mediante TCMD 64, independientemente del protocolo de estudio empleado, puede aportar información de utilidad...

Entrenador virtual de fibrobroncoscopia de bajo costo para enseñanza / Development of a virtual model of fibro-bronchoscopy

A virtual model of fibro-bronchoscopy is reported. The virtual model represents in 3D the trachea and the bronchi creating a virtual world of the bronchial tree. The bronchoscope is modeled to look over the bronchial tree imitating the displacement and rotation of the real bronchoscope. The parameters of the virtual model were gradually adjusted according to expert opinion and allowed the training of specialists with a virtual bronchoscope of great realism. The virtual bronchial tree provides clues of reality regarding the movement of the bronchoscope, creating the illusion that the virtual instrument is behaving as the real one with all the benefits in costs that this means.

Foreign body inhalations managed by rigid bronchoscope among children, in Shifa Hospital - Gaza, Palestine

To highlight foreign body [FB] inhalation and management by rigid bronchoscope in ENT department at Shifa hospital [Gaza-Palestine]. 150 cases were referred to ENT evaluation for possible FB inhalation, 104 [69.3%] with history of FB inhalation and 46 [30.7%] with history of respiratory illnesses. Patients studied aged 1 month to 8 years. Male/female ratio was 63.3/36. 88 [58.7%] of the cases presented with positive foreign body. Resting site[s] of foreign body: 3 [3.4%] cases presented with foreign bodies in the subglottis, 14 [15.9%] in trachea, 46 [52.3%] in right main bronchus, and 25 [28.4%] in left main bronchus. Types of foreign bodies observed: 35 [39.8%] patients examined had water melon seeds, 35 [39.8%] had bean, 14 [15.9%] had food particles, and 4 [4.5%] had plastic particles. The majority of patients treated had complete removal of FBs: 147 [98%] from the first intervention with bronchoscope and the rest FBs required a second intervention. No mortalities occurred amongst patients during the course of this study. rigid bronchoscope is a potentially safe and effective procedure for foreign body removal from the respiratory tract

Estudo comparativo entre sutura mecânica e manual em brônquio após pneumonectomia esquerda em cães (Canis familiaris): uma avaliação anatomopatológica / Comparative study between mechanical and manual sutures in the bronchus after left pneumonectomy in the dogs (canis familiaris): a pathological-anatomic evaluation

O objetivo deste estudo foi realizar um estudo experimental comparando-se sob o ponto de vista anatomopatológico as suturas manual e mecânica em brônquio principal após pneumonectomia esquerda em cães. Foram utilizados 18 cães, sadios, machos e fêmeas, adultos, sem raça definida, pesando entre 9 e 27,5 kg. Foram separados em 2 grupos de 9 cães, de acordo com o tipo de sutura empregada: Grupo A - sutura manual com fio polipropileno 5-0; Grupo B sutura mecânica com grampeador mecânico modelo TL- 30. Cada grupo foi subdividido em 3 subgrupos de 3 animais, sendo estabelecido estudo temporal aos 7, 15 e 36 dias de pós-operatório, onde foi realizada avaliação anatomopatológica da cicatrização das suturas manual e mecânica. Na avaliação histopatológica foram avaliados, qualitativamente e semi-quantitativamente, intensidade da inflamação, fibrose, vasos neoformados e presença ou não de tecido de granulação, granuloma tipo corpo estranho e necrose. Os resultados encontrados foram analisados estatisticamente. Com relação à análise rustopatológica, ocorreu a formação de granuloma tipo corpo estranho no coto brônquico esquerdo em 88,9% dos cães submetidos à sutura manual e em nenhum dos cães submetidos à sutura mecânica. Houve, ainda, diferença estatística significativa nos cães dos Grupos A e B em relação à intensidade da inflamação, sendo de maior intensidade nos cães submetidos à sutura manual. Concluiu-se que os 2 tipos de sutura promoveram cicatrização adequada do coto brônquico principal esquerdo, embora tenha ocorrido maior intensidade de inflamação e maior ocorrência de granuloma tipo corpo estranho nos cães submetidos à sutura manual.

Bronquiolite constritiva: aspectos tomográficos e correlação anatomopatológica / Constrictive bronchiolitis: tomographic aspects and pathologic correlation

Os autores relatam os principais aspectos da bronquiolite constritiva na tomografia computadorizada de alta resolução (TCAR) do tórax em ins e expiração, e os comparam aos achados anatomopatológicos, mediante estudo de três casos da doença em mulheres com idade entre 29 e 46 anos que apresentavam dispnéia incaracterística, de caráter progressivo, encaminhadas para realização de espirometria, TCAR do tórax e biópsia pulmonar. A TCAR do tórax em ins e expiração demonstrou, em dois casos, padrão de atenuação em mosaico difuso, acentuado na expiração. No terceiro caso foram observados nódulos centrolobulares, não sendo realizado estudo em expiração. O material histopatológico demonstrou estenose importante de luzes bronquiolares por espessamento fibroso da lâmina própria e atrofia do epitélio bronquiolar, alterações diagnósticas da bronquiolite constritiva. A realização de TCAR do tórax em ins e expiração mostrou-se de fundamental importância na suspeição de doenças relacionadas à obstrução de pequenas vias aéreas, sendo o aspecto de atenuação em mosaico na expiração característico da topografia periférica das lesões. O diagnóstico de bronquiolite constritiva deve ser confirmado por biópsia pulmonar por meio de toracotomia

We report the main findings of inspiratory and expiratory high-resolution computed tomography (HRCT) of the thorax in three women aged between 29 and 46 years with constrictive bronchiolitis and compare these results with the anatomopathological findings. The three women presented with progressive noncharacteristic dyspnea and were submitted to pulmonary function tests, HRCT of the thorax and lung biopsy. In two of the patients, inspiratory and expiratory HRCT of the thorax demonstrated a mosaic attenuation pattern that was accentuated during expiration. The expiratory phase was not performed in the third patient who presented centrilobular nodules. The pathology studies revealed significant bronchiolar stenosis due to fibrous thickening of the lamina propria and atrophy of the bronchiolar epithelium, which are diagnostic findings of constrictive bronchiolitis. Inspiratory and expiratory HRCT demonstrated to be of fundamental importance in the assessment of patients with diseases that cause obstruction of small airways. The mosaic attenuation pattern in the expiratory phase is characteristic of the peripheral topography of the lesions. The diagnosis of constrictive bronchiolitis should be confirmed by lung biopsy.

Ontogenic changes in the fractal geometry of the bronchial tree in Rattus norvegicus

Respiration and metabolism change dramatically over the course of the development of vertebrates. In mammals these changes may be ascribed to organogenesis and differentiation of structures involved in gas exchange and transport and the increase in size. Since young as well as mature individuals must be well-designed if the species is to survive, the physiological changes during the development should be matched with geometrical or structural adjustments of the respiratory system. The aim of this study was to evaluate changes in the fractal geometry of the bronchial tree during the postnatal development of the rat. The average fractal dimension of the bronchial tree of the rats was 1.587, but that of juveniles was larger than that of the adults. We found a significant negative correlation between age and fractal dimension. This correlation could be considered be misleading because of the difficulty of separating age/body size effects. Nevertheless, because fractal dimensions of the bronchial tree of rabbits and humans are known to be similar, 1.58 and 1.57 respectively, the body size effect may be nil. To our knowledge, this is the first report of ontogenetic changes in the fractal dimension of the bronchial tree in mammals.

Normal virtual endoscopic anatomy of the upper airway

Virtual endoscopic examination is an easy, accurate and non-invasive tool for evaluation of the endoluminal airway. Normal anatomy of the generated views should be studied by heart for any radiologist who wants to enter this challenging and amazing field. Twenty patients were selected with normal airway and they were examined by helical CT with a pitch factor of 1.5 and axial overlapped cuts were obtained. The raw data were transferred via a local area network to the [Easy Vision] workstation where the virtual endoscopic views were generated. Comparison with the normal conventional endoscopic examination was done. The data obtained from the virtual endoscopic were identical to that obtained from the conventional endoscopic examination. The aim of this work is to emphasis upon the normal virtual endoscopic anatomy of the upper airway for the radiologists going to enter this interesting field for better orientation and easy picking up of the pathological lesions

Caracterización de la geometría fractal del árbol bronquial en mamíferos / Measuring the fractal geometry of the bronchial tree in mammals

El árbol bronquial de los mamíferos presenta un diseño que se ha asociado con un adecuado flujo de gases a los alvéolos, una mínima producción de entropía en la mecánica respiratoria y con un mínimo costo en materia y energía. Sin embargo, la vía aérea constituye sólo parte del sistema respiratorio y como tal su geometría debe ajustarse a la función de todo el sistema resolviendo el problema de distribuir un volumen de aire inspirado en una gran superficie, dispuesta en un volumen acotado. Así, la topología bronquial exhibe las características de ocupar espacio con su ramificación progresiva y una reducción del diámetro de los bronquios que se ha asociado a una geometría fractal. En este trabajo se caracteriza la topología del árbol bronquial de Rattus norvegicus mediante su dimensión fractal y se compara con otros mamíferos de distinto tamaño: Oryctolagus cuniculli y Homo sapiens. Se estudia además el efecto de la escala para verificar la autosimilitud. Los resultados demuestran una geometría fractal de la vía aérea de las tres especies, que se mantiene a distintas escalas y son una demostración directa de este tipo de geometría. La topología se mantiene invariante en las tres especies, con dimensiones fractales entre 1,57 y 1,59. Los resultados coinciden con otros estudios realizados en la vía aérea, la superficie alveolar, la ventilación y la perfusión pulmonar. Se discuten las consecuencias de este tipo de geometría en el pulmón