title: Potentially overlooked branches of the left pulmonary artery.
abstract: BACKGROUND
  During pulmonary resection, we sometimes encounter "pitfall branches" of the pulmonary artery, which could cause serious vessel injury. Current computed tomography and computer-processing technology can identify the pulmonary artery along the peripheral bronchus, thereby revealing the true rates of different pulmonary artery branching patterns. Knowledge of these branching patterns allows safe and definitive surgery.
  
  
  METHODS
  In 186 cases of left lung resection performed at our institution from January 2006 to September 2011, two general thoracic surgeons and one radiologist independently reviewed computed tomography images and examined the branches of the pulmonary artery arising from the pars mediastinalis.
  
  
  RESULTS
  Branching patterns of the lingular artery included 17 (9.2%) cases with mediastinal origin, 50 (26.9%) with interlobar and mediastinal origin, and 119 (63.9%) with interlobar origin. The 2 types of lingular artery of mediastinal origin, which were potentially overlooked during surgery, were observed in 36.1% of cases. This was a higher rate than previously reported. Moreover, a mediastinal basal pulmonary artery (A(5+8+10) abnormal branching) was seen in one case.
  
  
  CONCLUSIONS
  Potentially overlooked branches of the left pulmonary artery arising from the pars mediastinalis are much more frequent than we expected. It is crucial to understand the branching pattern of the pulmonary artery by preoperative computed tomography assessment.
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Kariatsumari
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
authors.forename: Tsunayuki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan m-sato@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Masami
authors.initials: M
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000601:surgery; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000000981:diagnostic imaging*
keywords: Image processing; Imaging; Pneumonectomy; Pulmonary artery; Thoracic surgery; Tomography; X-ray computed; computer-assisted; three-dimensional; video-assisted