Reply

Abstract

I thank Dr Austin for his comment, and I am very glad that the article by my colleagues and me arouses interest. I fully agree that anatomical variations of the segmental veins are not exceptional, and knowledge of them may improve study of the lung and help surgeons avoid mistakes during operation. However, I believe that the articles cited in his letter strongly bear out our conclusions. The anatomical variant of venous drainage from the posterior segment of the right upper lobe described in our report drains directly into the left atrium without any relationship to the right superior or inferior pulmonary vein. This anatomical variant was identified during the right upper lobectomy [1Spaggiari L. Solli P. Leo F. Veronesi G. Pastonno U. Anomalous segmental vein for right upper lobe an unusual anatomical variation.Ann Thorac Surg. 2002; 74: 267Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. The superior pulmonary vein was isolated and resected, and no relationship between the anomalous vein and the right superior pulmonary vein was identified. During lymph node dissection, the right inferior pulmonary vein was dissected, and no relationship between it and the anomalous vein was observed. Afterward, the anomalous vein was sectioned separately. Crossing behind the bronchus intermedius and draining directly into the left atrium the segmental vein in our patient was a true, independent segmental pulmonary vein for the posterior segment of the right upper lobe. In the article by Dr Kim and associates [2Kim J.S. Choi D. Lee K.S. CT of the bronchus intermedius frequency and cause of a nodule in the posterior wall on normal scans.AJR. 1995; 165: 1349-1352Crossref PubMed Scopus (18) Google Scholar], the nodule in the posterior wall analyzed by thoracic computed tomographic scan was caused by a branch of the vein from the posterior segment of the right upper lobe draining into either the superior pulmonary vein or the inferior pulmonary vein. Thus, no independent veins draining directly into the left atrium were observed. The report by Jardin and Remy [3Jardin M. Remy J. Segmental bronchovascular anatomy of the lower lobes CT analysis.AJR. 1986; 147: 457-468Crossref PubMed Scopus (41) Google Scholar] identified 10 patients with a V3 pathway in which a vein from the right upper lobe drains into the right inferior pulmonary vein. No anomalous veins crossing behind the bronchus intermedius and draining directly into the left atrium were noted. In conclusion, I think that knowledge of segmental vein drainage is important for thoracic surgeons, and I believe that our report of an “exceptional” variant adds information to this field.