PUB041 Potentially Overlooked Branches of the Left Pulmonary Artery

Abstract

During pulmonary resection, we sometimes encounter ‘pitfall branches’ of the pulmonary artery (PA) which could cause serious vessel injury. Current computed tomography (CT) instrument and computer processing technology can identify the PA along the peripheral bronchus, thereby revealing the true rates of the different PA branching patterns. Knowledge of these branching patterns allows safe and definitive surgery. For 186 cases of left lung resection performed at our institution from January 2006 to September 2011, two general thoracic surgeons and one radiologist independently reviewed CT images and examined the branches of pulmonary artery arising from pars mediastinalis. Branching patterns of lingular artery included17 cases with mediastinal origin (9.2%), 50 cases with interlobar and mediastinal origins (26.9%), and 119 cases with interlobar origin (63.9%). The two types of lingular artery of mediastinal origin, which were potentially overlooked during surgery, were observed in 36.1% of cases. This was a higher rate than previously reported. Moreover, mediastinal basal PA (A4+5+8+10 abnormal branching) was seen in 1 case. Potentially overlooked branches of the left PA arising from pars mediastinalis are much higher than we expected. It is crucial to understand the branching pattern of the PA by preoperative CT assessment.