Lung Fissures Research Articles

Absence of horizontal fissure right lung

Objectives : To examine the dissected cadavaric right lungs for the presence or absence of minor (horizontal) fissure right lung . Design: Descriptive study. (cadavaric study). Place and duration: - The study was conducted in dissection halls of various Medical colleges of Lahore (FMHC, FJMC & KEMC) from January 2003 to February 2004. Material &methods: A total number of 112 cadavaric specimens of right lung were dissected &examined for the presence or absence of minor fissure. Results: - Out of 112 specimens 9(9%) of specimens were showing the absence of minor fissure of right lung whereas 103(91%) of specimens of right lungs were showing presence of minor fissure. Conclusion: The percentage of anatomical variation (absence)of minor fissure of right lung is 09%. The study of anatomical variations of fissures of lungs is important for anatomists, surgeons& radiologists.

The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves.Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%–85% for the right major fissure, 19%–74% for the left major fissure, and 20%–90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

Anatomical study on variations of fissures of lung

Aim: This study is conducted to record the variations in fissures and lobes of lung which will be helpful for all clinicians and also of academic interest. Materials and Methods: The study was undertaken in 25 pairs of cadaveric specimens. The lungs were exposed to study the morphological features like number, fissures and lobes. Presence of anatomical variations was observed and photographed. Results: 11 right side lungs showed incomplete horizontal fissure. In 5 right lungs there was no horizontal fissure. Incomplete oblique fissure was found in 7 right lungs. 2 right lungs did not have any fissures. 8 left lungs exhibited incomplete oblique fissure. Conclusion: A detailed knowledge of the anatomy of the fissures of lung is essential for the proper interpretation of radiological images like X- ray, CT scan and MRI for the radiologists, cardiothoracic surgeons performing lobectomies, and segmental resections. Furthermore, the knowledge of fissures and lobes of lungs is important for the surgeons to properly manage the potential problems which may be encounterd during surgery. Keywords: Lungs, Horizontal fissure, Oblique fissure, Variations

Morphological variation of human lung fissures and lobes: An anatomical cadaveric study in North Karnataka, India

Introduction: The lungs are a pair of vital organs of respiration which are divided into lobes by fissures. The fissures facilitate the movements of lobes and help in uniform expansion of the whole lungs. The fissure may be complete, incomplete, or absent. The knowledge of position and completeness of fissures and lobes is necessary for an appreciation of lobar anatomy and thus locating bronchopulmonary segments. Objectives: The objective of this study was to analyze the morphology of fissures and lobes of lungs. Materials and Methods: Twenty pairs of lungs were taken for the study, obtained from twenty formalin-fixed cadavers. The specimens were thoroughly observed for the pattern of lobes, fissure variations were noted, and the specimens were photographed. Results: Of the twenty right-sided lungs, incomplete oblique fissure was seen in six (30%) lungs. None of the lungs showed the absence of oblique fissure. Incomplete horizontal fissure was seen in ten (50%) lungs, and horizontal fissure was found absent in four (20%) lungs. Among the twenty lungs, four (20%) lungs showed two lobes due to the absence of horizontal fissure and the remaining 16 (80%) lungs showed normal lobar pattern of lungs. On the left side, incomplete oblique fissure was observed in two (25%) lungs, and two (25%) lungs showed the absence of oblique fissure. Due to the absence of oblique fissure, three (15%) specimens showed only one lobe while 17 (85%) lungs showed normal lobar pattern. There was no incidence of the presence of an accessory fissure in either side of the lungs. Conclusion: The present study when compared with a previous work showed a wide range of difference in the lobes and fissures between and among different populations. Knowledge of such variation may be important for performing lobectomies, surgical resections, and correct interpretation of radiological images.

3D Lung Fissure Segmentation in TC images based in Textures

Among all cancers, lung cancer (LC) is the most common of all malignant tumors. In order to obtain a more effective segmentation of pulmonary fissures, independent to other structures present in the CT scan, this paper proposes the segmentation of 3D fissures using texture measures and Artificial Neural Networks (ANN). The results of this study are based on voxels classified as fissure through the proposed method compared to the gold standard set by an expert. The results were analyzed using similarity coefficient rate of 95.6%, the rate sensitivity of 71.1% and specificity of 95.6% rate. Thus, it is possible to identify the job has a gain due to not using segmentation of other pulmonary structures and does not require the use of pulmonary atlas.

A Study of Anatomical and Morphological Aspects of Lung Fissures and Lobes

A Study of Anatomical and Morphological Aspects of Lung Fissures and Lobes

An aberrant anterior lobe and unusual accessory fissure of the left lung in human — anatomical and clinical considerations

Accessory fissures that separate aberrant lung lobes are not only interesting anatomical observations, but also have a definite importance as they may cause diagnostic confusion in radiological and pathological evaluations. In the case reported here, a rare type of separation of the left lung by an unusual fissure is described. The left lung of a 67-year-old Caucasian female cadaver showed an accessory fissure that crossed the mediastinal, apical and anterior costal surfaces. The aberrant fissure separated the organ into a small upper-medial anterior lung lobe (lobus minimus) and a much larger aberrant lobe (lobus magnus). At the pulmonary hilum, the artery, vein and bronchus of the small aberrant lobe were clearly identifiable. During analysis of radiological images such as X-ray and computed tomography, the existence of such aberrant fissures and lobes have to be known in detail in order to separate between simple anatomic variation of the lungs and a number of lung pathologies including scar, pulmonary bulla, atelectasis or even mediastinal mass. Keywords: aberrant lung lobe; accessory lung fissure; human; variation

Variations of the fissures of human lung – A cadaveric study

Variations of the fissures of human lung – A cadaveric study

Effects and possible mechanisms of mesenchymal stem cell transplantation on emphysema in rats

To explore the effects of transplanting bone marrow mesenehymal stem cells (MSCs) on emphysema in rats and elucidate the possible mechanisms. A total of 24 female Sprague-Dawley rats were randomly divided randomly into 3 groups of control, emphysema and MSCs transplantation (n=8 each). The rat model of emphysema was established by 14-week exposure to cigarette smoking and then MSCs labeled with 4, 6-diamidino-2-phenylindole (DAPI) were injected into recipient rats of MSCs transplantation group via tail veins. At 2 and 4 weeks post-transplantation, engraftment and differentiation of MSCs was determined. At 8 weeks post-transplantation, lung fissure sections were prepared for examining the morphological alterations. The apoptosis of alveolar septal cells was assessed. And the levels of oxidative stress in sera and lung were detected. At 2 and 4 weeks post-transplantation, MSCs labeled with DAPI could be found in recipient lungs, some of which differentiated into type II alveolar epithelial cells. Mean linear intercept was higher in emphysema and MSCs transplantation groups than control group [(111 ± 23) and (90 ± 15) vs (74 ± 10) µm], mean alveolar numbers were lower than control group [(94 ± 22) and (125 ± 15) vs (159 ± 22)/mm²] (all P<0.05); mean linear intercept was higher and mean alveolar numbers were lower in emphysema group than MSCs transplantation group (both P<0.05). The apoptotic index of alveolar wall cells in emphysema group was higher than MSCs transplantation group [(13.5 ± 2.5)% vs (4.8 ± 0.7)%, P<0.05]. Malondialdehyde of sera and lung in emphysema and MSCs transplantation groups was higher than control group [(4.3 ± 0.8), (3.7 ± 0.4) vs (3.0 ± 0.4) nmol/ml, (5.4 ± 0.5), (4.8 ± 0.4) vs (4.2 ± 0.6) nmol/mg, all P<0.05]; malondialdehyde of sera and lung in emphysema group was higher than MSCs transplantation group (both P<0.05). Superoxide dismutase (SOD) of sera and lung in emphysema and MSCs transplantation groups was lower than control group [(8.7 ± 0.8), (9.6 ± 0.7) vs (10.5 ± 0.9) U/ml and (56.3 ± 13.4), (70.2 ± 11.0) vs (84.9 ± 13.0) U/mg, all P<0.05]; SOD of sera and lung in emphysema group was lower than MSCs transplantation group (both P<0.05). MSCs transplantation via tail vein may arrest the progression of emphysema in a cigarette-smoke-induced rat model of emphysema through a differentiation of injected MSCs into type II alveolar epithelial cells and down-regulations of apoptosis and oxidative stress.

Absence of both fissures in a right lung: a case report

AbstractThe right lung has two fissures which separate the lung into three lobes. They are the oblique fissure and the horizontal fissure and the lobes are superior, middle and the inferior lobes respectively arranged from the apex of the lung to the base. In the present case, during routine dissection the right lung was observed to have complete absence of both oblique fissure and horizontal fissure and there was no lobar pattern. The lung pleural membrane was continuous from the apex to the base. Hilum structures were arranged normally. Left lung was completely normal with no variation. Variation of anatomy of lung fissures is important in case of diagnosis of lung pathologies and in the modality of treatment for segmental resection of lung.

Automatic Lung Lobe Segmentation and Fissure Extraction Using Itempls Method on Computer Tomography Images

This paper proposes an automatic lung lobe segmentation method in a supervised way. The lung image is given as input and the lung image is segmented using iterative threshold method. Then fissure information is enhanced using log supportive filter. Then Fissure locations are extracted using Vector training and matching process. Finally the lung lobes are segmented and marked as individual lobes. The main modules of this proposed method are Iterative threshold based lung segmentation, Fissure enhancement, fissure detection and Lung lobe segmentation. This proposed method can be used to find the missing fissures and unclear fissures also. This proposed method is working based on training of fissure information and detection is done according to the trained vectors. The proposed method segments the lung lobes with high performance and high speed.

Residual Post-Treatment FDG Avidity in Regional Lymph Nodes Impacts Local-Regional Control in Patients Receiving Definitive Chemoradiation for Non-small Cell Lung Cancer: A Secondary Analysis of ACRIN 6668/RTOG 0235

difficult to validate due to the lack of ground truth. This study aims to investigate a novel method, 3D Hyperpolarized Helium-3 (HP He3) tagging MRI, for evaluating lung ventilations and strains from direct measurements of lung deformation during breathing. Materials/Methods: A three-dimensional (3D) HP He-3 tagging MRI technique was developed for direct measurement of regional lung respiratory motion. Two healthy subjects were imaged under IRB-approved protocol at the end-of-inhalation (EOI) and end-of-exhalation (EOE) phases in a single scan using the HP He-3 MRI tagging technique. The 3D displacement vector field (DVF) of the lung between the EOI and EOE phases was determined by tracking the movements of the center of mass (CM) of the tagging grids in the HP He-3 MR tagging images. The strain tensor, which characterizes the 3D deformation of the grid, was computed from the relative displacements between the CM of each grid and its six nearest neighbors. Ventilations were then calculated using the principal strains (i.e., the eigenvalues of the strain tensor). Results: DVFs and volumetric maps of lung principal strains and ventilation were successfully generated for both subjects. Although Subject #1 had much larger respiratory motion amplitude than Subject #2 (5.8 0.5 cm vs. 3.6 0.5 cm), the first and second principal strains of the two subjects were found to be comparable (e1Z -0.45 0.03, e2Z -0.38 0.03, and e3Z -0.1 0.3 for Subject #1, and e1Z -0.41 0.02, e2Z -0.38 0.01, and e3Z -0.32 0.04 for Subject #2). The average ventilations in the left and the right lungs of two subjects were -73% 6% (left)/-62% 16% (right) and -72% 2% (left)/-71% 1% (right), respectively. Lung fissures were identifiable in the principal strain maps by larger values of e1 (-0.49 0.02), which results from the significant relative motions between lung lobes. Conclusions: A systematic approach was developed to generate 3D functional maps of ventilation and principal strains using HP He-3 tagging MR images obtained at different respiratory phases. This method holds great promise for revealing ground truth information about lung ventilation and strain, which may be applied to validate DIR based calculation, as well as for studying lung biomechanics. Author Disclosure: T. Cui: None. Q. Huang: None. W.G. Miller: None. X. Zhong: None. F. Yin: None. J. Cai: None.

Correlation between Collateral Ventilation and Interlobar Lung Fissures

Background: New bronchoscopic techniques for end-stage emphysema treatment are nowadays available; the presence of interlobar collateral ventilation (CV) and interlobar lung fissures (ILF) is crucial for patient selection. Objectives: Assessment of these variables has been reported previously, but it has never been anatomically validated in vivo. This is the purpose of our study. Methods: Twenty-one patients undergoing lung resection for lung cancer were prospectively enrolled in this study. At operation, CV was assessed by the Chartis® catheter system. ILF completeness at high-resolution computed tomography (HRCT) was retrospectively reviewed. The ILF status at HRCT and at surgery was compared; furthermore, the relationship between CV and ILF status was assessed. Results: At HRCT, ILF were incomplete in 18 cases; at catheter evaluation, CV was present in 11 cases; 15 patients had incomplete ILF at operation. HRCT specificity, sensitivity and accuracy were 33, 93 and 76% compared with ILF status at surgery. HRCT accuracy was 90% on the right and 63% on the left. We demonstrated a high grade of probability of CV presence and incomplete ILF at surgery (odds ratio = 10.0). Conclusions: There is a correlation between ILF status and CV. Both catheter evaluation of CV and HRCT assessment of ILF show some limitations. However, the cumulative information provided by these techniques allows to reliably assess the anatomical ILF status.

(814) - The Impact of Incomplete Pulmonary Fissures of Living Lobar Lung Transplant Donors on Bronchial Stenosis of Lung Recipients

Bronchial complications are among the most challenging problems after living-donor lobar lung transplantation (LDLLT), although the ischemic time of living-donor lungs can be minimized compared to cadaveric lung transplantation. To prevent bronchial complications, maintaining the pulmonary blood flow is critical for the bronchial healing. However, in the donor lobectomy of LDLLT, the inadequate dissection of interlobar fissures could cause unexpected obstruction of the pulmonary vessels and decreased blood flow to the bronchial anastomosis. The purpose of this study was to examine the relationships between incomplete pulmonary fissures of living-donor lungs and bronchial stenosis of LDLLT recipients. We retrospectively analyzed 127 donors and 69 recipients of bilateral and unilateral LDLLT at our institution between October 1998 and October 2013. According to Craig’s classification of pulmonary fissures, interlobar fissures of donor lungs were Grade 1 in 43, Grade 2 in 73, Grade 3 in 11 and Grade 4 in no donor. Postoperative lung perfusion scintigraphy was available in 119 of 127 transplanted lungs after LDLLT. Lung perfusion scintigraphy showed segmental defect or reduced blood flow in the lobar apex in 12 transplanted lungs (Group A), and homogenous distribution of blood flow in 107 transplanted lungs (Group B). Grade of interlobar fissures in Group A was significantly higher than that in Group B (2.1 ± 0.15 v.s. 1.7 ± 0.059; p < 0.05). While 3 of 12 (25 %) transplanted lungs in Group A revealed bronchial stenosis after LDLLT, no bronchial stenosis was encountered in 107 transplanted lungs of Group B. Our experience suggests that the incomplete pulmonary fissure of living-donors is a possible risk factor for bronchial stenosis of lung recipients in LDLLT. Careful dissection of incomplete pulmonary fissures should be required to maintain the pulmonary blood flow in the living-donor lobectomy.

(815) - Traffic Density Does Not Affect Lung Function in the First Year After Double Lung Transplant

s S295 anastomosis. The purpose of this study was to examine the relationships between incomplete pulmonary fissures of living-donor lungs and bronchial stenosis of LDLLT recipients. Methods: We retrospectively analyzed 127 donors and 69 recipients of bilateral and unilateral LDLLT at our institution between October 1998 and October 2013. Results: According to Craig’s classification of pulmonary fissures, interlobar fissures of donor lungs were Grade 1 in 43, Grade 2 in 73, Grade 3 in 11 and Grade 4 in no donor. Postoperative lung perfusion scintigraphy was available in 119 of 127 transplanted lungs after LDLLT. Lung perfusion scintigraphy showed segmental defect or reduced blood flow in the lobar apex in 12 transplanted lungs (Group A), and homogenous distribution of blood flow in 107 transplanted lungs (Group B). Grade of interlobar fissures in Group A was significantly higher than that in Group B (2.1 ± 0.15 v.s. 1.7 ± 0.059; p < 0.05). While 3 of 12 (25 %) transplanted lungs in Group A revealed bronchial stenosis after LDLLT, no bronchial stenosis was encountered in 107 transplanted lungs of Group B. Conclusion: Our experience suggests that the incomplete pulmonary fissure of living-donors is a possible risk factor for bronchial stenosis of lung recipients in LDLLT. Careful dissection of incomplete pulmonary fissures should be required to maintain the pulmonary blood flow in the living-donor lobectomy.

Incomplete Oblique Fissure, Absence of Horizontal Fissure: A Case Report

The right Lung classically has one oblique fissure and one horizontal fissure and Three Lobes namely Upper, Lower, and middle Lobes. Variations in the lung fissures and lobes have been described by many authors which have got their Surgical and Radiological importance. During Routine dissection in the Department of Anatomy, S.V. Medical College, Tirupati, we encountered an Incomplete oblique Fissure, Absence of Horizontal fissure in the Right Lung of an Adult male Cadaver. Anatomical Knowledge of the variations of Fissures of Lung are important for C.T. Surgeons performing Lobectomies, and Radiologists I. Introduction Right lung is broader and heavier than the left lung. Two fissures oblique and horizontal , divide it into three lobes namely, upper, middle and lower. The oblique fissure separates the lower lobe from the remaining two lobes. It runs obliquely and crosses the inferior border of the lung about 7.5 cm behind its anterior end. The horizontal fissure separates the upper and middle lobe. It begins from the oblique fissure, runs horizontally and cuts the anterior border at inner end of fourth costal cartilage. The longer and lighter left lung is divided into a superior and an inferior lobe by an oblique fissure which extends from costal to medial .surfaces of the lung both above and below the hilum 3 The fissures facilitate the movement of the lobes in relation to one another, which accommodates greater distention and movement of the lobes during respiration. The fissures may be complete, incomplete or absent. In case of complete fissure the lung lobes are held together only at the hilum by the bronchi and the pulmonary vessels. Parenchymal fusion of varied extent along the floor is found in case of incomplete fissure 4 . Knowledge of the anatomy and variations of the major fissures are essential for recognizing their variable imaging appearances as well as related abnormalities. The cardiothoracic surgeons performing segmental lung resections and the radiologists must have a detailed knowledge of variations of classical and accessory fissures regarding their length, depth, positions etc to have uncomplicated peroperative and postoperative events and proper radiological interpretations respectively.

Results of Li-Tho trial: a prospective randomized study on effectiveness of LigaSure(R) in lung resections

The role of electro-thermal bipolar tissue sealing system (LigaSure(®), (LS); Covidien, Inc., CO, USA) in thoracic surgery is still undefined. Reports of its use are still limited. The objective of the trial was to evaluate the cost and benefits of LS in major lung resection surgery. A randomized blinded study of a consecutive series of 100 patients undergoing lobectomy was undertaken. After muscle-sparing thoracotomy and classification of lung fissures according to Craig-Walker, patients with fissure Grade 2-4 were randomized to Stapler group or LS group fissure completion. Recorded parameters were analysed for differences in selected intraoperative and postoperative outcomes. Statistical analysis was performed with the bootstrap method. Pearson's χ(2) test and Fisher's exact test were used to calculate probability value for dichotomous variables comparison. Cost-benefit evaluation was performed using Pareto optimal analysis. There were no significant differences between groups, regarding demographic and baseline characteristics. No patient was withdrawn from the study; no adverse effect was recorded. There was no mortality or major complications in both groups. There were no statistically significant differences as to operative time or morbidity between patients in the LS group compared with the Stapler group. In the LS group, there was a not statistically significant increase of postoperative air leaks in the first 24 postoperative hours, while a statistically significant increase of drainage amount was observed in the LS group. No statistically significant difference in hospital length of stay was observed. Overall, the LS group had a favourable multi-criteria analysis of cost/benefit ratio with a good 'Pareto optimum'. LS is a safe device for thoracic surgery and can be a valid alternative to Staplers. In this setting, LS allows functional lung tissue preservation. As to costs, LS seems equivalent to Staplers.

A case of focal lung infarction following right upper lobectomy in case of undeveloped lung fissure

We present a case of infarction of residual upper lobe tissue during right upper lobectomy. We believe that although the blood supply to the upper lobe had been isolated and divided in order to perform the right upper lobectomy, residual right upper lobe had been left behind secondary to "poorly estimated" staple separation of the upper from the middle lobe in a patient with non-developed oblique fissure. We suggest that in this situation the upper lobe bronchus should be identified and clamped and the lung re-inflated in order to accurately demarcate the borders of the upper and middle lobe prior to the application of the stapler to prevent infarction of residual upper lobe tissue. Therefore, this case emphasises that routine lung inflation during fissure development in right upper lobectomy may prevent unpredictable complications.

B-006RESULTS OF LI-THO TRIAL: A PROSPECTIVE RANDOMIZED STUDY ON EFFECTIVENESS OF LIGASURE® IN LUNG RESECTIONS

The Electro-thermal bipolar tissue-sealing system (LigaSure®-Covidien) in lung resections is still undefined (although approved by FDA with limitations). Prospective randomized study of 100 consecutive patients undergoing lobectomy. After muscle-sparing-thoracotomy and classification of lung fissures (Craig–Walker's), patients with fissure 2-4 were randomized to Stapler-Group or LS-Group. In LS-Group, only LS was used, instead of staplers, for fissure completion. Cost-benefit evaluation was performed using Pareto-optimal-analysis. There were no significant differences between groups (demographic and baseline characteristics). No patients were withdrawn from study; no adverse-effects were recorded. There was no mortality or major complications. There were no statistically significant differences between outcomes in LS-Group compared with Staplers-Group for operative-time, or morbidity. In LS Group, there was a non-significant increase of postoperative air-leaks in the first 24 hours postoperatively, and a statistically significant increase of drainage amount, without differences in hospital length of stay. LS Group had favourable multi-criteria analysis of cost/benefit ratio with good Pareto optimality. LS is a safe device for lung resections and can be a valid alternative to staplers. LS allows for functional lung tissue preservation. LS is cost equivalent to Staplers. Nevertheless, larger series will be needed. All authors have declared no conflicts of interest.

Variations in the Inter-lobar Fissures of Lungs Obtained from Cadavers of South Indian Origin

El objetivo fue determinar las variaciones de las fisuras del pulmon y correlacionarlas con su importancia clinica. Se utilizaron 48 muestras de pulmon, 30 del lado derecho y 18 del izquierdo, obtenidos de cadaveres de origen del Sur de la India. Entre los pulmones, en el lado derecho, dos mostraron ausencia de la fisura horizontal, y 25 mostraron una fisura horizontal incompleta. La fisura oblicua fue incompleta en 15 pulmones y en 1 pulmon estuvo ausente. Se observo una fisura accesoria en 4 pulmones. Entre los pulmones del lado izquierdo, la fisura oblicua estuvo incompleta en 7 casos. La presencia de una fisura accesoria se observo en 5 casos. Con el desarrollo de tecnicas radiologicas, endoscopicas y el avance de la cirugia pulmonar, el conocimiento de las variaciones morfologicas de las fisuras de pulmon es de importancia para los medicos, permitiendo localizar correctamente el segmento broncopulmonar durante la lobectomia, y para los radiologos para interpretar correctamente las radiografias y las Tomografias Computarizadas.