Oblique Fissure Research Articles

Video-assisted thoracic surgery right upper lobe bronchial sleeve resection.

Video-assisted thoracic surgery (VATS) is a new technology for nearly 30 years in the field of thoracic surgery most watched. However, there are still some controversy concerning the technical difficulties, operation duration, the extent of lymph node dissection and perioperative complications for VATS sleeve bronchial lobectomy when handling the locally advanced central lung cancer (involving the trachea and/or main bronchus). A 66 years old man was admitted for coughing for 2 months. He had smoked for 30 years, 20 packs a day. Chest computed tomography (CT) revealed a 2.5 cm × 4.5 cm mass in the right upper lobe. Bronchoscopy demonstrated the tumor obstructing the right upper lobe bronchus and involved the right main bronchus and bronchus intermedius. Pathology was squamous cell carcinoma. His pulmonary function result was forced expiratory volume in 1 second (FEV1): 1.91 L (64.7% predicted), forced vital capacity (FVC): 4.36 L. He received general anesthesia with double-lumen endotracheal intubation and left lung ventilation. Left lateral decubitus position was chosen. The first 1.5 cm incision was selected in the eighth intercostal space in the midaxillary line, and was used for the camera. A 4 cm long incision was made in the 3rd intercostal space in the preaxillary line. A third 1.5 cm incision was performed in the 9th intercostal space in the postaxillary line for assistant. Pulmonary ligament and the entire right hilum were mobilized. Pulmonary vein is the most forward hilar structure, sometimes immediately prior pulmonary trunk. The right upper lobe vein was transected with a vascular stapler. Truncus and posterior ascending pulmonary artery were then divided and transected with a vascular stapler. Major and minor fissures were stapled by 60 mm green linear stapler. Following clearance of the mediastinal lymph nodes of level 7, 4R and 2R, the bronchial sleeve resection and reconstruction began. The distal right main bronchus and bronchus intermedius were fully mobilized to ensure adequate surgical exposure. Traction sutures were routinely placed on the lateral walls and to reduce tension. Interrupted sutures were chosen for bronchial anastomosis. Bronchial membrane was sutured first, and then circumference end-to-end anastomoses were carried out using 3-0 absorbable sutures. There were no complications and the patient was discharged 8 days postoperatively. The 3rd intercostal space of the anterior axillary line was suggested for right upper lobe bronchial sleeve resection. This incision can reduce the distance and angle between the anastomosis to the incision, providing convenient conditions for easy anastomosis. And avoid the operator fatigue for keeping the posture for a long time. Clearance of the mediastinal lymph nodes before cutting the bronchus was helpful for satisfied explosion of the right main bronchus, the upper lobe bronchus and bronchus intermedius. And this would avoid pulling bronchial anastomosis for mediastinal lymph nodes clearance. Interrupted suture was safe and effective for VATS bronchial anastomosis.

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.

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

Short linear shadows connecting pulmonary segmental arteries to oblique fissures in volumetric thin-section CT images: comparing CT, micro-CT and histopathology.

To retrospectively evaluate short linear shadows connecting pulmonary segmental arteries to oblique fissures in thin-section CT images and determine their anatomical basis. CT scanning was performed on 108 patients and 11 lung specimens with no lung diseases around the oblique fissures or hila. Two radiologists evaluated the imaging. The parameters included length, thickness of short linear shadows, pulmonary segmental artery variations, and traction interlobar fissures, etc. The short linear shadows were not related to sex, age, or smoking history. The lengths of the short linear shadows were generally within 10mm. The thicknesses of the short linear shadows ranged from 1 to 2mm. Of the patients, 26.9% showed pulmonary segmental artery variations; 66.7% of short linear shadows pulled oblique fissures. In three-dimensional images, the short linear shadows appeared as arc planes, with one side edge connected to the oblique fissure, one side edge connected to a pulmonary segmental artery. On the tissue slices, the short linear shadow exhibited a band structure composed of connective tissues, small blood vessels, and small lymphatic vessels. Short linear shadows are a type of normal intrapulmonary membranes and can maintain the integrity of the oblique fissures and hilar structure. • Volumetric thin-section CT scanning is commonly used to study lung anatomy. • Short linear shadows are a common intrapulmonary structure in thin-section CT. • Short linear shadows correlate with band structures on the correlative tissue slices.

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures.

We aimed to perform an imaging analysis of interlobar fissures and their variations using thin-section computed tomography (CT). Volumetric thin-section CT scanning was performed in 208 subjects. Interlobar fissures were observed on axial images, and reconstructed coronal and sagittal images were observed by multiplanar reformatting (MPR). The vessel distributions were verified by maximal intensity projection (MIP). On the axial images, the interlobar fissures were characterized by lines of hyperattenuation, bands of hyperattenuation, avascular zones, and mixed imaging. The interlobar fissures were divided into seven grades according to the percentage of defects over the entire fissure. On the axial images, of all interlobar fissures without avascular zones, 70.2% of the right oblique fissures (ROFs) and 94.2% of the left oblique fissures (LOFs) appeared as lines, and 83.2% of the horizontal fissures (HFs) appeared as bands. All of the interlobar fissures appeared as lines on the coronal and sagittal images. Of all cases, 17.8% showed fully complete interlobar fissures for all three fissures. Incomplete fissures included 41.3% of ROFs, 58.2% of HFs, and 45.2% of LOFs. In ROFs and LOFs, discontinuity was most frequently below 20%, while in HFs discontinuity was most frequently 41%-60%. The most common classification of incomplete interlobar fissures was a discontinuous avascular zone. Incomplete interlobar fissures are common variations of interlobar fissures. Techniques including volumetric thin-section CT, MPR, and MIP can assist in the diagnosis of incomplete interlobar fissures.

Medial Meniscal Tear in a Long Distance Runner

HISTORY: A 53 year-old male distance runner presents with a complaint of right medial knee pain for the past 3 years, Pain came on gradually and has worsened to the point where he is now unable to run more than one mile without experiencing excruciating pain that requires him to stop. He was previously an avid marathon runner who ran approximately 30-60 miles a week regularly. He reports no trauma to the knee nor any twisting or locking instances and had undergone physical therapy two years ago with minimal relief. No swelling, instability or locking of the knee. PHYSICAL EXAMINATION: Normal gait with walking and running. No pain with running a distance of 100 feet. The left knee was normal in appearance with no effusion or deformity. It exhibited full range of motion and intact strength. The right knee exhibited no effusion or deformity. There was moderate tenderness to palpation over the medial joint line. There was 5/5 strength and full range of motion on flexion and extension. The Lachmann’s test was negative. Varus/valgus tests negative. McMurray’s test negative. Patellar compression and apprehension tests negative. DIFFERENTIAL DIAGNOSIS: 1. Patello-femoral syndrome. 2. Degenerative joint disease. 3. Meniscal tear. TEST AND RESULTS: 1. Upright standing anterior-posterior and lateral views of the right knee:-Mild tri-compartmental osteoarthritis of the right knee with small supra-patellar effusion 2. MRI right knee without contrast: -Tear of the medial meniscal body and posterior horn with extruded flipped fragment of the body into the medial meniscal tibial recess. -Deep oblique fissure of the medial facet of the patella. -Mild lateral patellar subluxation and lateral tilt. FINAL WORKING DIAGNOSIS: Right knee medial meniscal tear with extruded flipped fragment of body into meniscal tibial recess. TREATMENT AND OUTCOMES: 1. Referral to physical therapy for right knee range of motion exercises and quadriceps and hamstring strengthening. 2. Referral to our sports orthopaedic surgeon for possible arthroscopy and meniscal repair. 3. Home exercise program to work on quad and hamstring strengthening as instructed by physician and physical therapist. 4. Will monitor progression with physical therapy and await recommendations from orthopaedic surgery colleagues.

FISSURES AND LOBES OF LUNGS: A MORPHOLOGICAL AND ANATOMICAL STUDY

Background and Aims: The fissures of the lungs serve as boundaries for the lobes of the lungs. They also acts as barriers to avoid the spread of pathologies .The proposed aim of the study was to study the fissures and lobes of the lungs and their variations and to compare them with previous studies and to find their clinical implications. Methods: Thirty pairs of lungs were used for the study, obtained from formalin-fixed cadavers of south-indian origin. The lung specimens were observed for the patterns of lobes and fissures, variations were noted and specimens were photographed. Results: Five right lungs showed absence of horizontal fissure. Out of thirty, twelve right sided lungs showed incomplete fissures.On the left side, seven specimens showed incomplete oblique fissure. In addition, two right-sided specimens and four left sided specimens showed presence accessory fissure. Conclusion: The results and their comparison with the previous works show that there is a wide range of difference in occurrence of major, minor and accessory fissures between and among different populations. Knowledge of such variations is mandatory for surgeons in pre-operative planning for performing pulmonary lobectomies and for radiologists for interpreting X-rays and CT scans.

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.

The accuracy of computed tomography to predict completeness of pulmonary fissures. A prospective study.

Endobronchial valves are a potential alternative to lung volume reduction surgery for advanced emphysema. The greatest improvements in pulmonary function are seen in patients with complete pulmonary fissures, as determined by computed tomography (CT). However, the accuracy of CT to predict completeness of pulmonary fissures has not been compared with the reference standard of direct observation during thoracic surgery. To determine the accuracy of CT scans to predict completeness of pulmonary fissures. We conducted a double-blind, prospective trial in which completeness of pulmonary fissures was evaluated by direct observation during thoracic surgery. Preoperative CT scans were independently reviewed by two dedicated thoracic radiologists and completeness of the fissures was recorded and compared with intraoperative findings. The fissures of 46 patients were evaluated. The positive predictive value of CT scan to detect a complete fissure was 100% for the right major fissure and 75% for the left fissure, but only 33% for the right minor fissure. CT scans had a negative predictive value of 29% in evaluation of the right major fissure. CT scans overestimate completeness of the right minor fissure and underestimate completeness of the right major fissure. These findings may have implications for the use of CT scans to select patients for endobronchial valve insertion.

Visibility and variability of pleural fissures on normal digital chest radiographs of 1,000 healthy adults.

To investigate the visibility and variability of pleural fissures on digital chest radiographs. Posteroanterior digital chest radiographs of 566 males and 434 females were retrospectively reviewed for the frequencies and/or appearances of various pleural fissures. The right only, left only and bilateral minor fissures were visible in 722 (72.2 %), 1 (0.1 %) and 7 (0.7 %) subjects, respectively. The right minor fissures were visible as more than one line in 219 (30.0 %) subjects, i.e., 2, 3 and 4 lines in 214 (29.3 %), 4 (0.5 %) and 1 (0.1 %), respectively. The 955 visible right minor fissures exhibited variable length (<1/3 of right hemithorax, 17.8 %; 1/3-2/3, 60.1 %; >2/3, 22.1 %), alignment (medial higher 40.9 %; lateral higher 54.2 %; horizontal 4.8 %) and contour (convex upward 68.6 %; convex downward 2.7 %; flat 24.9 %; sigmoid 3.8 %). Superolateral major fissures were visualized in 14.8 % (right only 3.0 %; left only 9.0 %; bilateral 2.8 %), superomedial major fissures in 0.3 % (right 0.1 %; left 0.2 %), vertical fissures in 0.5 % (right 0.2 %; left 0.3 %), inferior accessory fissures in 5.4 % (right 4.8 %; left 0.6 %), right superior accessory fissures in 1.2 % and azygos fissures in 0.2 %. The right minor fissure was most frequently visible and exhibited variable appearances. Other pleural fissures were occasionally seen.

Uniportal video-assisted thoracoscopic surgery right upper lobectomy with systematic lymphadenectomy in a semiprone position.

A 53-year-old male smoker was referred to our hospital with an enlarged lesion in the right upper lung. Computed tomography (CT) showed a 1.5 cm solid lesion with pleural indentation in the right upper lobe adjacent to the oblique fissure. The preoperative clinical diagnosis was stage I primary lung cancer. Uniportal video-assisted thoracoscopic surgery (VATS) right upper lobectomy in a semiprone position was performed in this case. Frozen section examination confirmed the diagnosis of lung adenocarcinoma, and systematic lymphadenectomy was then performed. A chest tube was placed at the posterior part of the incision through the dorsal thoracic cavity to the apex. The postoperative pathologic diagnosis was T2aN0M0 adenocarcinoma.

Anomalous fissures and lobes of human lungs of North Indian population of western U.P.

IntroductionHuman lungs are normally divided into lobes by complete fissures which facilitate the movements of lobes in relation to one another during respiration. The knowledge of normal and abnormal fissures and lobes is important because it is essential to clinicians & radiologists in making correct diagnosis and treatment of lung diseases. Lack of knowledge misleads a doctor in proper localization of pathological lesions & their spread; interpretation of lung diseases in X-ray & CT Scan and in planning surgical approach during thoracoscopic lung resection. Keeping the above facts in mind the present study was aimed to look into the incidence of morphological variations of lung anatomy in North Indian population of western U.P. region. MethodThe present study was conducted on 50 pair of lungs obtained from the cadavers available in the department of Anatomy of Santosh Medical College, Ghaziabad, Uttar Pradesh. The lungs were assessed for any gross deformity and examined for analysis of fissures and lobes. ResultThe study on Right Lungs revealed the absence of oblique fissure in 8% and absence of Horizontal fissure in 40% of cases. The incidence of incomplete oblique fissure was 24% and that of incomplete Horizontal fissure was 32%. In 20% of the lungs there was complete absence of horizontal and oblique fissures. None of the right lungs showed any accessory fissure. A variation in fissural pattern accordingly caused variation in lobar patterns. A study on Left lung revealed incomplete oblique fissure in 40% and presence of accessory fissures in 24% of cases. The complete absence of oblique fissure on left side was not seen. DiscussionConsidering the clinical importance of normal and anomalous pattern of fissures and lobes of lungs, it becomes obligatory for us to have a fair knowledge of this subject so that no mistake is committed in diagnosing and treating a patient with lung pathology.

A hybrid approach to segmentation of diseased lung lobes.

Complete segmentation of diseased lung lobes by automatically identifying fissure surfaces is a nontrivial task, due to incomplete, disrupted, and deformed fissures. In this paper, we present a novel algorithm employing a hybrid two-dimensional/three-dimensional approach for segmenting diseased lung lobes. Our approach models complete fissure surfaces from partial fissures found in individual computed tomography (CT) images. Evaluated using 24 patients' lungs with a variety of different diseases, our algorithm produced root-mean square errors of 2.21 ± 1.21, 2.51 ± 1.36, and 2.38 ± 1.27 mm for segmenting the left oblique fissure (LOF), right oblique fissure (ROF) and right horizontal fissure (RHF), respectively. The average accuracies for segmenting the LOF, ROF, and RHF are 86.59%, 84.80%, and 82.62%, using our ±3-mm percentile measure. These results indicate the feasibility of developing an automatic algorithm for complete segmentation of diseased lung lobes.

Migraine and Patent Foramen Ovale: Barking up the Wrong Tree?

Migraine and Patent Foramen Ovale: Barking up the Wrong Tree?

A NOVEL APPROACH TO DETECT FISSURES IN LUNG CT IMAGES USING MARKER-BASED WATERSHED TRANSFORMATION

Detection and segmentation of fissures is useful in the clinical interpretation of CT lung images to diagnose the presence of pathologies in the human lungs. A new automated method based on marker-based watershed transformation has been proposed to segment the fissures considering its unique structure as a long connected component. Marker based watershed transformation is applied and morphological operations are employed to specify the internal and external markers. The smaller regions in the resulting image are removed by a novel procedure called Small Segment Removal Algorithm (SSRA) to segment the fissures alone. The performance of the method is validated by experimenting with 6 CT image sets. An expert radiologist observation is used as reference to assess the performance. A promising accuracy of 96.61% is shown with the rms error in the range of 0.877±0.224 mm for the left oblique fissure and 0.803±0.262 mm for the right oblique fissure.

A cadaveric study of anatomical variations of fissures and lobes of lung

Abstract Background and aim: The anatomical variations of fissures and lobes of lungs have been described by many research workers on CT scans, whereas, there were fewer studies done on gross anatomical specimens. Materials and methods: In the present study, 30 embalmed cadavers have been dissected and lungs were examined for fissures and lobes. Results: Nine out of 30 left lungs showed incomplete oblique fissures. Eight out of 30 right lungs showed incomplete transverse fissure but oblique fissure was complete, and in two right lungs, incomplete oblique and transverse fissures were found. In one cadaver one accessory lobe and one accessory fissure was present, on right side. Comparative analysis of present work with data in literature suggest that different studies performed on radiological images reported greater prevalence of incomplete or absence of pulmonary fissures as compared to present cadaveric study. Therefore our findings with regard to fissures and lobes are different from many studies but are approximately similar to two. Conclusion: Variation of lung anatomy is important for cardio-thoracic surgeons, radiologists for interpreting x-rays, CT scans and MRI and also it is of academic interest to all medical persons.

Duplicate caudate lobe of liver with oblique fissure and hypoplastic left lobe of liver (915.2)

The aim of study is to report a new anatomical variant of human liver and associated clinical significance. During routine dissection of abdomen, a liver of 55 year aged male cadaver was found to have multiple anomalies. Measurements of shape and size of these anomalies were taken.The caudate lobe was uncommonly duplicated by a angular fissure of length 2.5 cm and an oblique fissure of length 2 cm on this lobe placed inferiorly was also observed in this specimen. There was vertical furrow of length 6 cm and depth 2 mm on the right lateral surface of liver besides above malformations. The left lobe of liver was hypoplastic. These are new variants in the normal morphology of liver.These anomalies are of paramount importance to clinicians involved in the diagnosis and management of hepatic diseases, anatomists and morphologists for variant morphology, embryologists for new developmental defect and radiologists for misinterpretation of images of liver.

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.

Automatic pulmonary fissure detection and lobe segmentation in CT chest images.

BackgroundMulti-detector Computed Tomography has become an invaluable tool for the diagnosis of chronic respiratory diseases. Based on CT images, the automatic algorithm to detect the fissures and divide the lung into five lobes will help regionally quantify, amongst others, the lung density, texture, airway and, blood vessel structures, ventilation and perfusion.MethodsSagittal adaptive fissure scanning based on the sparseness of the vessels and bronchi is employed to localize the potential fissure region. Following a Hessian matrix based line enhancement filter in the coronal slice, the shortest path is determined by means of Uniform Cost Search. Implicit surface fitting based on Radial Basis Functions is used to extract the fissure surface for lobe segmentation. By three implicit fissure surface functions, the lung is divided into five lobes. The proposed algorithm is tested by 14 datasets. The accuracy is evaluated by the mean (±S.D.), root mean square, and the maximum of the shortest Euclidian distance from the manually-defined fissure surface to that extracted by the algorithm.ResultsAveraged over all datasets, the mean (±S.D.), root mean square, and the maximum of the shortest Euclidian distance are 2.05 ± 1.80, 2.46 and 7.34 mm for the right oblique fissure. The measures are 2.77 ± 2.12, 3.13 and 7.75 mm for the right horizontal fissure, 2.31 ± 1.76, 3.25 and 6.83 mm for the left oblique fissure. The fissure detection works for the data with a small lung nodule nearby the fissure and a small lung subpleural nodule. The volume and emphysema index of each lobe can be calculated. The algorithm is very fast, e.g., to finish the fissure detection and fissure extension for the dataset with 320 slices only takes around 50 seconds.ConclusionsThe sagittal adaptive fissure scanning can localize the potential fissure regions quickly. After the potential region is enhanced by a Hessian based line enhancement filter, Uniform Cost Search can extract the fissures successfully in 2D. Surface fitting is able to obtain three implicit surface functions for each dataset. The current algorithm shows good accuracy, robustness and speed, may help locate the lesions into each lobe and analyze them regionally.

Morphological variations of the lungs: a study conducted on Indian cadavers.

Awareness of anatomical variations in lungs is essential during segmental or lobar resections of lungs. We studied the variations of fissures, lobes and hilar structures in 65 right and 73 left isolated lungs from the dissection hall. Horizontal fissure was absent in 3.07% and incomplete in 35.38% of right lungs. Four point six one percentage of right lungs had 3 fissures and 4 lobes. Three point zero seven percentage of right lungs had 3 arteries, 67.69% had 2 arteries, and 29.23% had only one artery in the hilum. Sixty-three point zero seven percentage of right lungs had two veins in the hilum; 32.30% had 3 veins in the hilum; and 4.61% had more than 3 veins in the hilum. Ninety-eight point four six percentage of right lungs showed 2 bronchi in the hilum, and 1.53% of them showed 3 bronchi in the hilum. Two of the right lungs (3.07%) had an artery passing across the oblique fissure. Fifteen point zero six percentage of left lungs showed incomplete oblique fissure and 2.73% showed 2 fissures and 3 lobes. Five point four seven percentage of left lungs showed 2 arteries and 94.52% had only one artery in the hilum. Eighty point eight two percentage of left lungs had two veins in the hilum and 19.17% had 3 veins in the hilum. Twenty-one point nine one percent of left lungs had 2 bronchi and 78.08% had only one bronchus in the hilum. The knowledge of variations in the lobar and hilar anatomy of the lung presented in this study is clinically important while interpreting the radiological images and performing surgical procedures.