Accessory Fissure Research Articles

Anatomical variations in lung fissures leading to supernumerary lobes in the lungs

IntroductionLung fissures are partially incomplete in 50% of different populations. Incomplete formation of the fissures leads to a merging of lobes and conversely accessory lobes form due to the formation of new fissures. This study aims to describe the morphology of the lungs in terms of fissures and lobes. Materials and methodsA descriptive observational study was done on a total of 82 formalin fixed bodies. Both the left and right lungs of each body were examined for accessory lobes and fissures. ResultsA wide range of variations was seen in the present study. On the right, the horizontal fissure was absent in six lungs (7.3%), incomplete in 32 lungs (39.0%) and complete in 33 lungs (40.2%). No lungs had an absent oblique fissure. The oblique fissure was incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). No right lung solely had an oblique fissure absent. However, both the horizontal and oblique fissures were absent in one lung (1.2%). In the left lungs, the obliques fissure was absent in one lung (1.2%), incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). An accessory fissure was seen in the territory of the upper lobe forming a partial separation in the right superior lobe of one lung. ConclusionThe high prevalence of morphological variations in this study emphasizes the need for greater understanding of lung fissure anatomy. For example, in video-assisted thoracoscopic surgery lobectomies, higher morbidity in patients is linked with incomplete fissures [12]. Thus, more knowledge of lung fissure and lobe variations will be of significant clinical relevance to anatomy students, cardiothoracic surgeons, and radiologists.

A Case of Accessory Anterior Hepatic Fissure

The hepatic diaphragmatic surface is usually smooth and featureless. Although the existing literature mentions grooves or fissures on the diaphragmatic surface, there is no consensus regarding its causative factors. During routine dissection, the authors found a liver with a broad accessory fissure on the anterior surface of the anatomical right lobe. An enlarged hepatic area was observed on the left side of this accessory fissure. The undersurface of the right hemidiaphragm had a diaphragmatic band that extended into the hepatic fissure. The morphometry of the accessory fissure was studied. Retrospective magnetic resonance imaging showed that the middle hepatic vein was to the immediate right of the accessory fissure. Histological examination was done to confirm the presence of muscle tissue in the hypertrophied diaphragmatic band. As the need for surgeries and transplantations of the liver rises, there is a need to understand the hepatic macroscopic anatomy and its radiological correlation.

Variations in Pulmonary Fissure: A Source of Collateral Ventilation and Its Clinical Significance.

Introduction: Oblique and horizontal fissures divide the lungs into lobes. Assessing the incompleteness or absence of fissures is important when planning any surgical procedure in this region. This study aimed to investigate the incidence of variations in the fissures and their implication in clinical practice.Methods: The sample consists of 70 formalin-fixed lungs (32 right and 38 left lungs). These lungs were assessed for complete, incomplete, and absent fissures and any variations in the fissures on the sternocostal and mediastinal surfaces.Results: Oblique fissure was incomplete on the sternocostal surface in 18.75% and 21% and on the mediastinal surface in 25% and 21% on the right and left lungs, respectively. Additionally, it was absent in 10.5% of the left lung samples. The horizontal fissure was incomplete in 12.5% on both surfaces and was absent in 25% on the right lung samples, of which 50% had no oblique fissure. No accessory fissure was seen in any of the lungs.Conclusion: Incomplete and absent fissures can be observed in the right as well as the left lung, suggesting the source of collateral ventilation. This study imparts important information to pulmonologists doing bronchoscopic lung volume reduction therapy or bronchopulmonary segment resection and also to radiologists and anatomists.

A comprehensive study and extensive review of morphological variations of liver with new insights.

Liver is divided into four anatomical lobes presenting minor fissures and invisible major fissures. The prevalence of Accessory Fissures in liver ranges widely from 6 to 94%. The morphometric analysis of individual lobes is also scarce in literature. There have been instances where the surgeon has experienced some of these variations as a surprise during surgery as the existing data on the surface variations of liver is still contradictory. A sound knowledge of these variations would aid the surgeons and radiologists to circumvent the misdiagnosis and complications during surgeries. The study was conducted in 93 cadaveric livers. Minor liver fissures, Accessory fissures and lobes were noted and measured. The livers were classified according to the Netter's classification. The morphology of caudate and quadrate lobes was studied. Any other variations in the appearance of groove for Inferior vena cava, gall bladder and its fossa were also studied. The results are tabulated. The study revealed several variations in the morphological features of liver. Accessory fissures were noted in 51.61% of livers, distributed on various liver surfaces. Accessory lobes were noted in 27.9%. Pons hepatis was present in 22.5%. Gall bladder variations that were noted include the Hartmann's pouch (n = 14; 15.05%) and the Phrygian cap (n = 2; 2.15%). 65.6% livers (n = 61) had the sulcus of the caudate process or fissure of Gans or Rouviere sulcus which is a normal fissure present in majority of normal healthy livers. The current study provides a complete understanding and a thorough knowledge of surface morphological variations in liver. We hope that this will be greatly helpful for surgeons and radiologists to avoid possible errors in interpretations, to plan appropriately and assist during liver surgeries and to do radiological interventions.

Morphological variations of lung lobes and fissures: a preliminary study

IntroductionAnatomical variations of the lung lobes and fissures have implications in diagnostic radiology and thoracic procedures. The prevalence of these variations is not reported in Sri Lanka. MethodsA cross-sectional study was conducted on cadavers to assess the morphological variations of lung lobes and fissures. The presence and absence of lung lobes and fissures were reported in addition to describing the completeness of the major lung fissures. ResultsA total of 24 lungs in 12 cadavers were studied. Inferior accessory fissures were noted in one right and one left lung of two independent cadavers. Two cadavers had no horizontal fissures, and one left lung had an incomplete oblique fissure posteriorly. Azygos lobe was not observed in this study sample. ConclusionsThe morphology of lung lobes and fissures demonstrate a notable variability, on par with previous reports. Further studies with a large sample size in our population are necessary for generalizable results.

Study on Anatomical Variations in Fissures of Lung by CT Scan.

Introduction Refinements in the modern computed tomography (CT) imaging techniques have led to anatomical variations in the fissures of lung being diagnosed more frequently. So far, majority of the studies conducted are cadaveric. There is paucity of studies in this aspect based on chest CT images. Hence, we undertook this study to find the anatomical variations in the fissures. Prior detection of anatomical abnormalities is important to reduce postoperative complications in lung resection surgeries. Materials and Methods This was a cross-sectional study conducted over a period of 2 years. Data were collected from the patients who underwent CT scan thorax. Patients in whom normal anatomy of lung was distorted and cases where both lungs were not visualized completely were excluded from the study. All the CT images were reviewed by a single radiologist. The presence or absence of the normal and accessory pulmonary fissures, as well as the continuity of each fissure, was recorded by the radiologist. Data were compiled and analyzed. Results The study population consisted of 394 (70.4%) males and 166 (29.6%) females, totaling 560 cases. Fissural variations were detected in 22.9% ( n = 128). Also, 17.5% ( n = 98) fissural variations were seen in males and 5.4% ( n = 30) fissural variations were seen in females. Further, 54.7% ( n = 70) of variations were detected in the right lung and 45.3% ( n = 58) in the left lung. The most common fissural variation noted was right incomplete oblique fissure with a frequency of 8.4% cases ( n = 47). The most common accessory fissure detected was inferior accessory fissure. Total 22 cases were detected in both the lungs, 17 cases in male and 5 in female. Conclusion Anatomical variations in fissures were found to be more in the right lung than the left lung. Accessory fissures were detected in higher incidence on the right side.

A left lung with four lobes: a new discovery during the thoracotomy for recurrent primary spontaneous pneumothorax

BackgroundThe right and left lung anatomy are similar but asymmetrical. The right lung consists of three lobes, and the left lung consists of two lobes. Our study is unique because of discovering a very rare morphological feature of the left lung which has not been reported yet. By the way, we compared two different available chemical agents for pleurodesis (talc and bleomycin) according to side effects, complications, and pneumothorax recurrence.Case presentationWe reported a case of bilateral primary spontaneous pneumothorax, who underwent talc slurry and bleomycin pleurodesis at right and left side retrospectively, and then complicate with left-sided recurrent spontaneous pneumothorax, so underwent open thoracotomy and was surprisingly and accidentally found to have 4 lobes and 3 fissures in left lung.ConclusionIn our case report, there were one main oblique fissure and two accessory fissures which divided the lung into 4 separated lobes, and this discovery in human’s and other animals’ lung anatomy has not been previously reported. In our case study, the talc slurry was more effective in preventing spontaneous pneumothorax recurrence, but with more side effects than bleomycin. We could hypothesize that the morphological variation of the lung might affect spontaneous pneumothorax development and recurrence.

Human Liver Morphology: Anatomical Study about the External Aspects

Knowledge of the anatomy of liver is a prerequisite for a complete understanding of the mechanics ofdiagnostic imaging and minimally invasive surgical approaches. So the aim of the study is to carry outthe morphological feature of right lobe, left lobe, caudate lobe, quadrate lobe and surfaces of liver. Thisis retrospective observational study done on 75 human livers irrespective of age and sex in Department ofanatomy, Smt. B.K. Shah Medical Institute and Research Center, Vadodara, Gujarat. The livers were studiedfor morphological variationsuch as accessory fissure, accessory mini lobe, Quadrant lobe with tongue likeprojection, Pons hepatis connecting left lobe with quadrate lobe, Riedel’s lobe present, Narrow and elngatedleft lobe, Absence of quadrant lobe, Absence of fissure for ligamentum teres, Bilobed caudate lobe andclassified according to Netter’s classification.Out of 75 embalmed human liver 23 (30.67%) livers werenormal and 52 (69.33%) livers shown one or more than one morphological variation of liver. Out of 52 liverfound abnormal fissures were in 23 (30.67), pons hepatis in 2 (2.66%), riedel’s lobe in 3 (4%), absence ofquadrant lobe in 1(1.33%) deep renal impression and corset constriction observed in 15 (20%) specimensof liver, diaphragmatic deep groove were observed in 1 (1.33%) specimen. The presence of knowing extralobes and fissure lies in the fact that might help to interpretation during imaging of hepatobilliary system andmay intern lead to surgical implication in operation theater.

Variations in the Human Pulmonary Fissures and Lobes: A Cadaveric Study

The objective of this study was to describe the variations in human pulmonary fissuration in a cadaveric Kenyan population. Data were collected from 48 formalin-fixed cadavers in the department of Human Anatomy, University of Nairobi, Kenya; with 38 right and 32 left lungs meeting the study’s inclusion criteria. The fissures were studied irrespective of the cadaver’s sex and were classified anatomically as proposed by Craig and Walker (1997). Out of the 38 right lungs examined, the horizontal fissure was absent in 4 lungs (10.5%), incomplete in 16 lungs (42.1%), and complete in 18 lungs (47.3%). Out of the 32 left lungs, the oblique fissure was incomplete in 11 lungs (34.4%) and complete in 21 lungs (65.6%). An accessory fissure was observed in 3 right lungs (7.9%); 2 of which were inferior accessory fissures and 1 being an azygous fissure. Twelve left lungs (37.5%) had an accessory fissure; all of which were left minor fissures. The present study details important variations in the anatomy of the human pulmonary fissure in Kenya. Knowledge and awareness of these findings are paramount, due to their implications in clinical practice, such as in the interpretation of thoracic images by radiologists and preoperative planning by thoracic surgeons.

Morphological Study of Human Cadaveric Liver and its Surgical Significance

Introduction: The liver is the largest organ of the abdominal viscera. Knowledge of anatomy of liver and its variations is indispensable for accurate diagnosis of cases by radiologists, and prevention of unwanted surgical complications by surgeons. Many researchers have studied the segmental anatomy of the liver, but there are very few studies regarding the surface variations of liver. Aim: To document the surface variations of liver and discuss them from clinical perspective. Materials and Methods: This observational cross-sectional study was conducted from August 2015 to May 2019 on 50 liver specimens in the Department of Anatomy, Vardhman Mahavir Medical College. These livers were observed for any surface variations such as abnormal fissures or lobes, elongation or hypoplasia of lobes, etc. Data were tabulated and stats were calculated in percentages. Descriptive analysis of data has been carried out and mentioned in the study. Results: In the present study, out of 50 liver specimens, variations were observed in 42 (84%) specimens. Accessory fissures were seen in 16 (32%) specimens. Elongated left lobe was present in 7 (14%) specimens. Pons hepatis, which is a bridge of tissue connecting the quadrate lobe and the left lobe was observed in 8(16%) specimens. Caudate lobe variations observed in this study were abnormal fissures and hypertrophied papillary process. Conclusion: The present study documents frequent morphological variations of liver such as elongated left lobe, accessory lobes, etc. Elongated left lobe may be related to fundus of stomach which should be kept in mind during left lobe resection. The radiologists can confuse accessory lobes or projections with pathological mass. Knowledge of these variations will undoubtedly help radiologists and surgeons to prevent misdiagnosis of cases and plan newer and safer surgical procedures.

Study of Morphological Variations of Liver and it's Clinical Significance

Aims and objectives: It is very important for radiologists and surgeons to update knowledge of normal and variant liver morphology before diagnosing any liver diseases. Methods: 50 formalin fixed livers were utilized for the studying the morphological variations of livers. Results: In the present study, 20 livers were normal and 30 livers showed morphological variations out of which 6 livers were with accessory lobes, 8 with accessory fissures, 6 with lingular process and 5 with diaphragmatic sulci. Conclusion: This study highlights presence of morphological variations, whose knowledge is important for surgeons and radiologists.

Splenic abscess and accessory liver fissure: When anatomy meets surgery

Splenic abscess and accessory liver fissure: When anatomy meets surgery

A morphological study of human cadaveric liver and its clinical importance in Gujarat

The liver is the largest gland of the body. It is involved in various metabolic activities. It is present in right hypochondrium, epigastric and reach up to left hypochondrium. Due to presence of falciform ligamentum, liver is divided into anatomical 5/6 right and 1/6 left lobe. During intrauterine life right lobe is larger due to haematopoiesis, but the haemopoietic function of liver is diminishes sufficiently in last two month leads to progressive reduction of its size which mostly affect left lobe. The study was carried out on 50 embalmed liver present in department of anatomy, GMERS medical college, Dharpur, Patan, Gujarat over the period of three year. Liver observed macroscopically for presence of any accessory lobe or fissure, then take photograph for record and further analysis. In our study out of 50 specimens 29(58%) specimen normal without any morphological changes, while in 21(42%) there are various changes. Out of 42% there is presence of accessory lobe in 7(14%), accessory fissure & grooves in 9(18%), Abnormal elongation of left lobe in 4 (8%) specimen and Riedel’s lobe in 1(2%) specimen. To identify primary or metastatic hepatic carcinoma hepatic imaging technique is best tool, in which various major fissure & lobes are very important landmark to mark the lobar anatomy and liver lesions. So it is helpful to radiologist as well as the surgeons to plan surgery accordingly. Keywords: Liver, Accessory lobe, Accessory fissure, Caudate lobe, Quadrate lobe.

A Morphological Study on Gross Anatomical Variations of Embalmed Cadaveric Livers

Objective: To find out gross anatomical variations of embalmed cadaveric livers. Methods: Present study was conducted in dissection halls of Anatomy departments of Allama Iqbal Medical College, Lahore, Sahiwal Medical College, Sahiwal and Fatima Jinnah Medical University, Lahore during 2016-2019. In this study, 74 livers were dissected out from embalmed cadavers and preserved in 10% formalin. Different morphological variations were observed in livers which included presence of accessory lobes, accessory sulci, notches, changes in size and shape of lobes. Liver specimens were photographed and classified according to Netter's classification of morphological variations of liver. Results: The hepatic morphological variations observed included accessory fissures in the right, left, caudate and quadrate lobes of the liver, accessory lobes, elongated left lobe, hypoplastic left lobe, multiple deep diaphragmatic sulci, pons hepatis, Reidel's lobe, notched borders and bilobed caudate lobe. Conclusion: The knowledge of various variations in morphology of cadaveric livers may help the radiologists to make accurate interpretation of the radiological images, thus minimizing the chances of incorrect reporting. It may also be helpful to the hepatobiliary surgeons to be aware of the morphological variations on the liver surface to avoid surgical complications. Key Words: Embalmed cadaveric livers, accessory lobes, accessory fissures

Accessory and Incomplete Lung Fissures: Clinical and Histopathologic Implications.

This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures. Accessory and incomplete pulmonary fissures are often overlooked during routine imaging but can have profound clinical importance. Knowledge of fissure anatomy could improve diagnostic accuracy and inform prognosis for oncologists, interventional pulmonologists, and thoracic surgeons.

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.

Clinically significant observations of hepatic lobe morphology in adult human cadavers

To determine and analyse clinically significant changes in hepatic lobe morphology. An observational study was conducted over 42 adult human livers which were acquired during routine dissections conducted for the first MBBS students over a period of two years (2017-2019) at Dr. PSIMS & RF. Macroscopic thorough examination of the liver specimens was done through borders, surfaces and changes the in parenchymatous tissue was duly documented and photographed. The common finding was prevalence of accessory fissures(50%) followed by pons hepatis (19%) which was identified as bridging the fissure for ligamentum teres(9.5%) and encapsulating the inferior vena cava in 9.5% of liver specimens. Accessory lobes account for a total of 16.6%,with incidence of Riedel's lobe being 7.1%. Tongue like process of left lobe were encountered in 9.5% specimens. Unique finding in the present study was of a liver specimen which had multiple variations on visceral, anterior and superior surfaces. Present study comprised of multiple variations in hepatic lobe morphology, which are of great clinical significance and are interest for radiologists and gastroenterologist. Studies on liver morphology would expand the knowledge for surgical inventions and help in preventing diagnostic errors in imaging techniques.

ANOMALOUS PERITONEAL FOLDS OF LIVER WITH INCOMPLETE FISSURE FOR IGAMENTUM TERES - A CASE REPORT

Liver is the largest organ in the human body occupying right hypochondrium, epigastrium and left hypochondrium. The organ develops in the ventral mesogastrium dividing the latter into a cranial part which forms the falciform ligament and lesser omentum and the caudal part which normally degenerates but may persist occasionally in the form of accessory fissures, ligaments and folds. The present case report describes the occurrence of exceptional and multiple abnormal peritoneal ligaments extending between the liver, diaphragm and abdominal wall. In concurrence, an incomplete fissure for ligamentum teres hepatis is reported which resulted in a communication between the left lobe and quadrate lobe of liver. The knowledge of the normal and the variant anatomy of such peritoneal reflections of liver is of colossal significance for surgeons performing the segmental resection of the liver and radiologists interpreting radiological findings related to liver.

Types of pulmonary fissures and its surgical implications: A cadaveric study

Being the essential organs of respiration, pair of lungs are situated on either side of the mediastinum. Each lung is divided into lobes by the fissures. These fissures allow for proper expansion of lungs and on the other hand fissures may have a role in restricting infection to a particular lobe. Fissures may be complete, incomplete or absent.To study the variations in the fissures of lung, compare the results with the available data and to discuss the surgical importance of this study. 37 pairs of lungs (37 right and 37 left) from formalin fixed cadavers were observed and classified into different grades of fissures ( as per Craig and Walker criteria). Presence of accessory fissures was noted.Out of the 37 right lungs, 3 showed absence of horizontal fissure and the same fissure was incomplete in right sided 17 lungs. Among the left lungs, 9 had incomplete oblique fissure. Accessory fissure were found in 2 right and 1 left lungs.The current study showed that right lung may be without horizontal fissure or fissures may be incomplete. Thus, a light on these variations by the cardiothoracic surgeons will help in better planning of surgeries like lobectomy. Knowledge about the fissures will aid in arriving at better diagnosis for the clinicians and radiologists.

A study on the morphological variations of the liver and its clinical significance

Introduction: Liver is a wedge shaped visceral organ in the body, occupies right hypochondrium, epigastric region and extends in to left hypochondrium. A thorough knowledge of anatomy of liver and its variations will avoid errors in diagnostic imaging and will also help the surgeons design appropriate surgical approaches. Materials and Methods: The study was conducted in the Department of Anatomy of our Institution. A total of 35 numbers of livers removed from cadavers were used for the study. The morphological variations of liver such as changes in size, shape, presence of accessory lobes, fissures, hypoplastic lobes were noted and tabulated. Results: Out of the 35 livers studied, 15 specimens (42.9%) exhibited normal fissures and lobes, 13 (37.1%) had accessory fissures over different lobes. In 3(8.6%) specimens of liver hypoplastic left lobe was observed and in 4(11.4%) specimens lingular process of left lobe was observed. There were 8 accessory fissures were seen in right lobe, 5 in left lobe, 4 in caudate lobe and 5 in quadrate lobe. Out of 35 livers studied, accessory lobes were observed in 9 liver specimens, which can be grouped as 1 in right lobe, 2 in left lobe, 5 in caudate lobe and 1 in quadrate lobe. Conclusion: The authors conclude that morphological variations of liver must be taken in to account by the Radiologist and G a stroenterologist while making various differential diagno sis as these variations can present various clinical manifestations/ implications. Keywords: Liver, Morphology, Variations, Lobes, Fissures.