A cadaveric study on accessory lobes of lungs and their bronchial branching pattern
Abstract
Background: An accessory lobe is a part of lung tissue separated off by an accessory fissure. It develops due to occasional monopodial branching of the stem bronchi. Different accessory lobes may be encountered in the human lungs e.g., azygos lobe, dorsal lobe, cardiac lobe and tracheal lobe. An accessory lobe may be confused with a lung abscess or bulla in x-ray and CT-scan, and its variable bronchial supply may cause difficulty during bronchoscopy. Hence, the present work has been carried out to study the accessory lobes and their bronchial branching pattern in human lungs.
Materials and Methods: 92 adult human lungs (46 right and 46 left) were collected from the Department of Anatomy and Department of Forensic and State Medicine, Gauhati Medical College and Hospital, Guwahati, Assam and preserved in 10% formalin. The lungs were, then, examined for accessory lobes and their bronchial supply was noted following dissection from the hilum.
Results: In the present study, the azygos lobes were present in 2.17% of cases and dorsal lobe was present in 1.08% of cases, all of which belonged to the right side. The azygos lobes were supplied by the apical segmental bronchus of the right superior lobe and dorsal lobe was supplied by the apical basal segmental bronchus and posterior basal segmental bronchus of the right inferior lobe.
Conclusion: A detailed knowledge of the accessory lobes and their bronchial supply is important for correct radiological diagnosis and bronchoscopic examination of lungs.
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References
Godwin JD, Tarver RD. Accessory fissures of the lung. AJR Am J Roentgenol. 1985 Jan;144(1):39-47.
Boyd JD, Hamilton WJ, Mossman HW. Alimentary and respiratory system, pleural and peritoneal cavities. In: Prenatal Development of Form and Function Human Embryology. 4th ed. Heffer; 1972. p.330.
Standring S. Thorax. In: Gatzoulis MA, editor. Gray’s Anatomy The anatomical basis of clinical practice. 40th ed. Edinburgh: Elsevier Churchill Livingstone; 2008. p.992-1006.
Muttikkal TJ, Deng C. Non-azygos accessory fissure in right upper lobe associated with superior and inferior accessory fissures in right lower lobe. J Clin Imaging Sci. 2012;2:79. doi: https://dx.doi.org/10.4103%2F2156-7514.105133. Epub 2012 Dec 27.
Stibbe EP. The Accessory Pulmonary Lobe of the Vena Azygos. J Anat. 1919 Jul;53(Pt 4):305-14.
Moore KL, Persaud TVN. Respiratory System. In: Clinically Oriented Embryology The Developing Human. 9th ed. Saunders Elsevier; 2013. p.199-210.
Arakawa T, Terashima T, Miki A. A human case of an azygos lobe: determining an anatomical basis for its therapeutic postural drainage. Clin Anat. 2008 Sep;21(6):524-30. doi: https://doi.org/10.1002/ca.20679.
Soper WB. Accessory lobes of the human lungs. Trans Am Climatol Clin Assoc [Internet]. 1932 [cited 2017 October02];48(1):160-8.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2194448/pdf/tacca200001-0211.pdf
Hollinshead WH. Thorax. In: Anatomy for Surgeons. 2nd ed. Joanna Cotler Books; 1971. p.75-8.
Anson BJ, Siekert RG, Richmond TE, Bishop WE. The accessory pulmonary lobe of the azygos vein. Q Bull Northwest Univ Med Sch [Internet]. 1950 [cited 2017 September 29];24(4):285-90. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3802999/pdf/QBullNorthwestUnivMedSch-24-4-285_65.pdf
Chabot-Naud A, Rakovich G, Chagnon K, Ouellette D, Beauchamp G. A curious lobe. Can Respir J. 2011 Mar-Apr;18(2):79-80. doi: https://doi.org/10.1155/2011/474678.
Denega T, Alkul S, Islam E, Alalawi R. Recurrent hemoptysis- a complication associated with an azygos lobe. The Southwest Respiratory and Critical Care Chronicles. 2015;3(11):44-7. doi: 10.12746/swrccc2015.0311.146.
Fukuhara S, Montgomery M, Reyes A. Robot-assisted azygos lobectomy for adenocarcinoma arising in an azygos lobe. Interact Cardiovasc Thorac Surg. 2013;16(5):715-7. doi: https://doi.org/10.1093/icvts/ivt021.
Sadler TW. Respiratory system. In: Langman’s Medical Embryology. 12th ed. Wolters Kluwer Health Lippincott Williams & Wilkins; 2012. p.201-7.
Romanes GJ. Thorax and abdomen. In: Cunningham’s Manual of Practical Anatomy. 15th ed. Oxford: Oxford University Press; 2014. p.33.
Mata J, Cáceres J, Alegret X, Coscojuela P, De Marcos JA. Imaging of the azygos lobe: normal anatomy and variations. AJR Am J Roentgenol. 1991;156(5):931-7. doi: https://doi.org/10.2214/ajr.156.5.2017954.
Rauf A, Rauf WU, Navsa N, Ashraf KT. Azygos lobe in a South African cadaveric population. Clin Anat. 2012 Apr;25(3):386-90. doi: https://doi.org/10.1002/ca.21243. Epub 2011 Jul 28.
Özdemir L, Özdemir B, Duman T. Prevalence of an azygos lobe using thoracic computed tomography. Cyprus J Med Sci. 2016;1(1):55-7. doi: https://doi.org/10.5152/cjms.2016.97.
Crawford JH. Tomographic appearance of the azygos lobe with a description of two cases and a report of seven cases. Br J Radiol. 1944;17(202):319-22. doi: https://doi.org/10.1259/0007-1285-17-202-319.
Ashwini H, Archana MH, Jaishree H. Azygos lobe of right lung- a case report. Indian Journal of Medical Case Reports [Internet]. 2013 [cited 2017 December 24];2(3):11-3. Available from: http://www.cibtech.org/jcr.htm
Radha K, Duraipandian K. Adams lobe- a case report. J of Evidence Based Med & Hlthcare [Internet]. 2014 [cited 2017 December 25];1(4):235-7. Available from: https://www.jebmh.com/data_pdf/Radha.pdf
Bray G. Two cases of accessory lobe of the azygos vein. Proc R Soc Med [Internet]. 1932 [cited 2016 April 23];26(2):148-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2204248/pdf/procrsmed00708-0082b.pdf
Takasugi JE, Godwin JD. Left azygos lobe. Radiology. 1989;171(1):133-4. doi: 10.1148/radiology.171.1.2928516.
Kobayashi T, Satoh K, Kawase Y, Mitani M, Takahashi K, Nakano S, Ohkawa M, Tanabe M. Bronchial and vascular supply in azygos lobe of inflated fixed lung: a case study. Radiat Med [Internet]. 1995 [cited 2016 October 14];13(1):31-3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/7597202.
Kim WS, Kim MK, Kim SI, Han SR, Jeong O. Azygos lobe of Korean. Korean J Phys Anthropol. 2001;14(4):307-16. doi: https://doi.org/10.11637/kjpa.2001.14.4.307.
Chiba S, Suzuki T, Takahashi D, Kasai T. An autopsy case of azygos lobe and the extra-pulmonary course of the bronchial veins in man. Okajimas Folia Anat Jpn. 1990;66(6):313-37. doi: https://doi.org/10.2535/ofaj1936.66.6_313.
Ndiaye A, Ndiaye NB, Ndiaye A, Diop M, Ndoye JM, Dia A. The azygos lobe: an unusual anatomical observation with pathological and surgical implications. Anat Sci Int. 2012 Sep;87(3):174-8. doi: https://doi.org/10.1007/s12565-011-0119-5. Epub 2011 Oct 28.
Ando T. Studies on the posterior lobe of the lung in twins. Okajimas Folia Anat Jpn [Internet]. 1951 [cited 2017 November 07];23(2):81-94. Available from: https://www.jstage.jst.go.jp/article/ofaj1936/23/2/23_81/_pdf
Mawatari T, Murakami G, Koshino T, Morishita K, Abe T. Posterior pulmonary lobe: segmental and vascular anatomy in human specimens. Clin Anat. 2000;13(4):257-62. doi: https://doi.org/10.1002/1098-2353(2000)13:4%3C257::AID-CA5%3E3.0.CO;2-5.
Sreenivasulu K, Anilkumar P, Gaiqwad MR. Morphological anatomy of accessory fissures in lungs. Indian J Tuberc [Internet]. 2012 [cited 2016 June 29];59(1):28-31. Available from: http://medind.nic.in/ibr/t12/i1/ibrt12i1p28.pdf