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


METHODS
We 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.


RESULTS
Variations 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 "B(1)- or B(2)-defective branch type" bronchus was noted in 19 cases (7.2 %), which was a higher prevalence than that in previous reports.


CONCLUSIONS
We 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.
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Toshiteru
T
Nagashima
Kimihiro
K
Shimizu
Yoichi
Y
Ohtaki
Kai
K
Obayashi
Seiichi
S
Kakegawa
Seshiru
S
Nakazawa
Mitsuhiro
M
Kamiyoshihara
Hitoshi
H
Igai
Izumi
I
Takeyoshi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000033:anatomy & histology / Q000098:blood supply; D001995:Bronchography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008168:Lung / Q000033:anatomy & histology / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D014132:Trachea / Q000033:anatomy & histology / Q000098:blood supply / Q000000981:diagnostic imaging; D055815:Young Adult