The Study On Sectional Anatomy Of Segmental And Subsegmental Bronchovasculature Of The Lungs

Objective: To explore the anatomic characteristics of the bronchi, arteries, and veins of pulmonary segments on the transverse sections. Methods: Using serial transverse sections of thorax of 44 adult cadavers and multislice spiral CT images of 10 healthy volunteers, the segmental and subsegmental bronchi, arteries, and veins of the lungs were traced. Their anatomic relationships were also evaluated. Results: From the tracheal bifurcation to superior and inferior basal veins, 7 typical cross sections on the right and 6 typical cross sections on the left were chosen to show the anatomic characteristics of the ductal structures of pulmonary segments clearly. The right lung: ①On the section through tracheal bifurcation, the apical segmental artery, bronchus, and posterior segmental vein were lined successively from medial to lateral sides right to arch of azygous vein. ② On the section through right superior lobar bronchus, posterior segmental vein descends between posterior and anterior segmental bronchi. ③ On the section through intermediate bronchus, right superior lobar artery ascends anterior to intermediate bronchus. The apical, anterior, and posterior segmental veins can be seen near the pulmonary hilum. ④ On the section through the interlobar artery, right superior lobar vein, interlobar artery, and intermediate bronchus were arranged in proper order from before backwards. The origin of the superior segmental artery of lower lobe can be found on the sections of 33 cadavers (75%). ⑤ On the section through the bifurcation of intermediate bronchus, right middle and inferior lobar arteries run lateral to corresponding bronchi. ⑥ On the section through the basal trunk of bronchus, it can be seen that middle lobar vein drained into left atrium directly on the sections of 11 cadavers (25%). The medial basal segmental bronchus usually appears with intersegmental branch of superior segmental vein. ⑦ On the section through superior and inferior basal veins, the segmental arteries generally lie toward the lung periphery relative to their corresponding bronchi, the segmental veins generally lie central to their corresponding bronchi. The left lung: ① On the section through tracheal bifurcation , in front of the apicoposterior segmental vein , anterior segmental artery lie on the medioanterior side of anterior segmental bronchus.Behind the apicoposterior segmental vein, apicoposterior segmental artery ascends inside its corresponding bronchus. ? On the section through bifurcation of pulmonary trunk, apicoposterior and anterior segmental arteries arise from left pulmonary artery. The apicoposterior and anterior segmental bronchi lie on the lateral side of left pulmonary artery. On the sections of 27 cadavers (61.4%), left pulmonary artery and anterior segmental artery which together like a fishhook draws left superior pulmonary vein.(3)0n the section through left superior lobar bronchus, left superior lobar bronchus lies in center. Before it, anterior segmental vein converges into left superior pulmonary vein. Behind it, superior segmental artery arises from left inferior lobar artery. ?On the section through left inferior lobar bronchus, superior segmental bronchus appears. The inferior lingular bronchus lies in center of the superior lobe. Before it, lingular venous trunk converges into left superior pulmonary vein. Behind it, lingular arterial trunk arises from left inferior lobar artery. ? On the section through basal trunk bronchus, the branch of basal trunk artery can be seen on the lateral side of basal trunk bronchus. On the medioposterior side of it, the lateral ramus of superior segment vein goes inside. ? On the section through superior and inferior basal veins, medioanterior, lateral and posterior basal bronchi arrange clockwise. The basal segmental arteries lie toward the periphery relative to their corresponding bronchi, the segmental veins lie centrally to their corresponding bronchi. Conclusions: The segmental and subsegmental bronchi, arteries, and veins of the lungs can be recognized correctly on the transverse sections by finding landmark structures.Objective: To explore the anatomic characteristics of the bronchi, arteries, and veins of pulmonary segments on the sagittal sections. Methods: Using serial sagittal sections of thorax of 15 adult cadavers and multislice spiral CT images of 2 healthy volunteers, the segmental and subsegmental bronchi, arteries, and veins of the lungs were traced. Their anatomic relationships were also evaluated. Results: The bronchi and blood vessels in left pulmonary segments mostly are distributed on the 4 sagittal sections from the bifurcation of left principal bronchus to left side of cardiac apex. ? On the section through the bifurcation of left principal bronchus, left inferior lobar bronchus backward sends out superior segmental bronchus. Blow it, superior segmental vein and common basal vein are forming left inferior pulmonary vein. (2) On the section through the interlobar division of left pulmonary artery, apicoposterior segmental vein, anterior segmental vein and Iingular venous trunk form left superior pulmonary vein anterior to left superior lobar bronchus. Basal trunk bronchus of inferior lobar sends out medioanterior, lateral and posterior basal bronchus. ? On the section through cardiac apex, left superior lobar bronchus sends out the whole segmental bronchi, posterior intersegmental ramus of apical posterior segmental vein, inferior ramus of anterior segmental vein. And Iingular venous trunk, which can be used to divide adjacent pulmonary segments, the segmental arteries apart fron left inferior lobar artery lie superior to the corresponding bronchi. ?On the section through the left side of cardiac apex., intersegmental ramus of apical posterior segmental vein, inferior ramus of anterior segmental vein and superior, inferior Iingular segmental veins are lined successively from poserosuperior to antero inferior sides in the superior lobe of left lung. In the inferior lobe of left lung, segmental bronchi lie in center. The corresponding arteries lie superior to segmental bronchi. The corresponding veins lie inferior to segmental bronchi.The bronchi and blood vessels in right pulmonary segments mostly are distributed on the 3 sagittal sections from the bifurcation of right principal bronchus to right side of right atrium. ?On the section through the bifurcation of right principal bronchus, right superior lobar artery sends out apical and anterior segmental arteries anterior to right superior lobar bronchus. Interlobar bronchus divided into middle and inferior lobar bronchus. Right inferior lobar bronchus backward sends out superior bronchus, downwards sends out medial basal bronchus. ?On the section through interlobarartery, Right superior lobar bronchus sends out apical, posterior and anterior bronchi. Basal trunk bronchus sends out anterior , lateral and posterior basal bronchi. Superior and inferior basal veins lie inferior to basal trunk bronchus. (§)On the section through the bifurcation of interlobar artery, posterior segmental vein lies between anterior bronchus and posterior bronchus. Apical segmental vein and anterior segmental vein merge into apicoanterior vein. Middle lobar bronchus sends out lateral and medial bronchi. The segmental arteries arising from inferior lobar artery lie superior to their corresponding bronchi. Conclusions: On the sagittal sections, the bronchi and blood vessels in pulmonary segments relatively intensive, at the same time their origin and axes easily show. So the sagittal section is the advantaged section displaying the bronchi and blood vessels of pulmonary segments and subsegments. Objective: To explore the anatomic characteristics of the bronchi, arteries, and veins of pulmonary segments on the coronal sections. Methods: Using serial coronal sections of thorax of 20 adult cadavers, multislice spiral CT images of 4 healthy volunteers, the segmental and subsegmental bronchi, arteries, and veins were traced and pulmonary segments were divided on the coronal section. Results: The pulmonary segments mainly distributed on 10 sections from sternal angle to vertebral column. The section through the bifurcation of trachea is the best beginning section for the division of pulmonary segments on the coronal section. There are 6 key sections for division of pulmonary segments on coronal section: (D On the section through ascending aorta, the apical segmental vein, lateral segmental vein, apicoposterior segmental vein, left anterior segmental vein, and superior lingular vein appeared. Those veins are the landmarks for the division of pulmonary segments. (D On the section through pulmonary bifurcation, the left and right superior pulmonary veins can be seen under the pulmonary bifurcation. It appeared on the coronal sections of 11 cadavers (55%) that apicoposterior segmental vein, anterior segmental vein, and lingular venous trunk drained into left superior pulmonary vein simultaneously. (3) On the section through bifurcation of trachea, left and right superior lobar bronchi and their branches demonstrated clearly. Under the bifurcation of trachea, it can be seen that left and right inferior pulmonary veins empty them into left atrium. ? On the section through intermediate bronchus, the origin of segmental bronchi, arteries, and veins of bilateral lungs can be found. (D On the section through thoracic aorta, superior segmental and lateroposterior basal segmental bronchovasclature appeared mainly. ? On the section through spinal column, the inferior lobes of bilateral lungs showed the bronchi, arteries, and veins of superior, lateral basal, and posterior basal segments mainly. Conclusions: The pulmonary segments can be divided exactly on the coronal section by recognizing the lobar and segmental bronchi, arteries, and veins of the lungs carefully.