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Double Superior Segmental Bronchi of Lower Lobes
NOTES
Double Superior Segmental Bronchi of Lower Lobes Sherman W. Atwell
I
n a study of 1,200 consecutive bronchograms, the most common anomaly was the double superior segment of the lower lobes. Eighty-five patients (7%) had 88 of these abnormalities: 49 (4%) on the right and 39 (3%) on the left. During segmental resection, this anomaly sometimes intrudes its aberrant branches into adjacent segmental areas (Figs. 1-5). Boyden [l] reports 7% separate-stem superior segments, but surprisingly his are divided into 6% on the right (6 out of 100) and .9% on the left (1 out of 120). In our less exact bronchographic studies no “probables” were included, but the impression is that the actual incidence would be at least 6% on the right and nearly that on the left. T h e bronchographic group is selective since each case had some pulmonary involvement as a reason for inclusion. Only 1 case had ectasia in the superior segments (a part of universal bronchiectasis). Three of the right-sided cases had other anomalies, as did 2 on the left. Three cases had bilateral double superior segmental bronchi. One case has been reported in which a bronchial adenoma was found in the upper superior segment on the right [2]. From the Overholt Thoracic Clinic, Boston, Mass. Accepted for publication Apr. 14, 1966.
VOL. 2, NO.
5,
SEPT.,
1966
755
A
B
FIG. 1. ( A ) I n the anteroposterior position, the right double superior segment usually can be identified by the upper branch fanning outward over the middle lobe stem. T h e lower branch can be seen under the middle lobe stem. (B) The superior segments are shown in heavy line.
B
A
FIG. 2. (A, B ) T h e right lateral of the same case. These stems are often perpendicular to the intermediate bronchus.
756
THE ANNALS OF THORACIC SURGERY
NOTE:
Double Bronchi of Lower Lobes
B
A
FZG. 3. ( A , B ) Zn the left posterior oblique position the left double superior segment is identified as a branch at right angles to the left lower stem, below the regular superior branching and above the acute angulations of the basilar bronchi.
A FIG. 4.
B (A, B ) T h e left lateral view of the same case. VOi. 2, NO. 5 , SEPT.,
1966
757
ATWELL
A
B
FIG. 5 . (A, B ) The only triple stem superior segment found in the series.
REFERENCES
1. Boyden, E. Segmental Anatomy of the Lungs. New York: McGraw-Hill, 1955. 2. Demetriades, A., and Folayes, S. A case of supernumerary right bronchus with accessory hypoplastic lobe containing a bronchial adenoma. Amer. Rev. Tuberc. Pul. Dis.75:326, 1957.
758
THE ANNALS OF THORACIC SURGERY
Double Superior Segmental Bronchi of Lower Lobes Sherman W. Atwell
I
n a study of 1,200 consecutive bronchograms, the most common anomaly was the double superior segment of the lower lobes. Eighty-five patients (7%) had 88 of these abnormalities: 49 (4%) on the right and 39 (3%) on the left. During segmental resection, this anomaly sometimes intrudes its aberrant branches into adjacent segmental areas (Figs. 1-5). Boyden [l] reports 7% separate-stem superior segments, but surprisingly his are divided into 6% on the right (6 out of 100) and .9% on the left (1 out of 120). In our less exact bronchographic studies no “probables” were included, but the impression is that the actual incidence would be at least 6% on the right and nearly that on the left. T h e bronchographic group is selective since each case had some pulmonary involvement as a reason for inclusion. Only 1 case had ectasia in the superior segments (a part of universal bronchiectasis). Three of the right-sided cases had other anomalies, as did 2 on the left. Three cases had bilateral double superior segmental bronchi. One case has been reported in which a bronchial adenoma was found in the upper superior segment on the right [2]. From the Overholt Thoracic Clinic, Boston, Mass. Accepted for publication Apr. 14, 1966.
VOL. 2, NO.
5,
SEPT.,
1966
755
A
B
FIG. 1. ( A ) I n the anteroposterior position, the right double superior segment usually can be identified by the upper branch fanning outward over the middle lobe stem. T h e lower branch can be seen under the middle lobe stem. (B) The superior segments are shown in heavy line.
B
A
FIG. 2. (A, B ) T h e right lateral of the same case. These stems are often perpendicular to the intermediate bronchus.
756
THE ANNALS OF THORACIC SURGERY
NOTE:
Double Bronchi of Lower Lobes
B
A
FZG. 3. ( A , B ) Zn the left posterior oblique position the left double superior segment is identified as a branch at right angles to the left lower stem, below the regular superior branching and above the acute angulations of the basilar bronchi.
A FIG. 4.
B (A, B ) T h e left lateral view of the same case. VOi. 2, NO. 5 , SEPT.,
1966
757
ATWELL
A
B
FIG. 5 . (A, B ) The only triple stem superior segment found in the series.
REFERENCES
1. Boyden, E. Segmental Anatomy of the Lungs. New York: McGraw-Hill, 1955. 2. Demetriades, A., and Folayes, S. A case of supernumerary right bronchus with accessory hypoplastic lobe containing a bronchial adenoma. Amer. Rev. Tuberc. Pul. Dis.75:326, 1957.
758
THE ANNALS OF THORACIC SURGERY