Bilateral Accessory Lung Fissures with a Variant Left Bronchial Tree

Abstract

Accessory lung fissures are commonly noted, while bronchial branching abnormalities are less frequently found and are proposed to occur in 0.1–2% of the general population. Multiple accessory fissures, variant normal fissures of both lungs, and an altered left bronchial tree are unique to this case and is being reported due to its clinical significance. During a routine dissection of the thoracic cavity of an 85‐year‐old female cadaver, abnormal fissures were noted on both the right and left lungs, which were photographed. The bronchial branching was further dissected by tracing the bronchus from the hilum to the lung tissue. The right lung had a normal oblique fissure, while the horizontal fissure was shallow and incomplete. The left lung had a normal oblique fissure, and a minor fissure was noted running along the junction of the anterior (S3) and superior lingular (S4) bronchopulmonary segments. Accessory fissures were noted on both right and left lungs. The left bronchus was short and displayed an early division into upper and lower divisions. The dissection of the bronchial tree of the left lung showed trifurcation of the upper division into apicoposterior, anterior, and lingular bronchi. The lower division was normal. The right bronchial tree showed normal division. Examination of the heart revealed an atrial septal defect. The other thoracic and abdominal structures were examined and appeared normal. Knowledge of accessory fissures in the lung have importance in the clinical diagnosis of lobar pneumonia versus atelectasis with imaging and during resection of bronchopulmonary segments. Understanding this bronchial variation and anomalies have implications in diagnosis and endobronchial treatment, including airway stenting, bronchoscopy, endoscopy biopsy, and laser therapy.Support or Funding InformationTouro College of Osteopathic Medicine, Department of Anatomy