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

OBJECTIVES: 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. CONCLUSION: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11748-015-0531-1) contains supplementary material, which is available to authorized users.