Morphological Variations of the Lungs: A Cadaveric Study

The lungs are the organs of respiration which are situated on either side of the heart and other mediastinal contents in its pleural cavity. A fresh lung is spongy, can float in water and crepitates when handled. Lungs are important with respect to its blood circulation. The lungs are divided by fissures into lobes which facilitate movements of lobes in relation to one another. The hilum of each lung is its gateway. In the present study, we aim to assess the morphological variations of human cadaveric lungs at Chitwan Medical College (CMC). An observational study was conducted at dissection hall of anatomy department at Chitwan Medical College from September 2019 to October 2020 after taking ethical approval form Institutional Review Committee of CMC. All the intact 70 lungs present in the department were studied. Photographs of the intact lungs were taken from different surface. The lungs were porus, highly elastic and spongy in texture. On keeping lungs to water tank it got floated. We found 34(80.96%) of the studied specimen of right side had horizontal fissure present in it. The remaining 8 (19.04%) specimens did not have horizontal fissures, while 3 (5.88%) specimens had incomplete fissures. The oblique fissure was not present in 2 (2.38%) of the study specimens. The left side of the study specimen has a variance of 1(4.16%). When the hilum right lung was examined, 40 (95.23%) of the structure had the usual organization pattern. In the left lung, the usual pattern of organization was 21(75%). The differences are thought to be present in the lung’s fissure and hilum. The current study’s findings are therapeutically important. The findings could prove beneficial to cardiovascular and thoracic surgeons.

Anatomical Variation in the Fissurization of Lung with Embryological and Clinical correlations- A Case Report

Lungs are paired conical organs present in the thoracic cavity, which are responsible for gaseous exchange for oxygenation of blood. Both the lungs are divided into lobes by fissures. The right lung is divided into upper, middle and lower lobes by two fissures. The fissures are horizontal and oblique fissure whereas the left lung is divided into upper and lower lobes by oblique fissure. The left lung is divided into upper and lower lobe by oblique fissure. Both the lungs have ten bronchopulmonary segments (structurally separate and functionally independent units). Embryological evidence showed that the lungs developed from the endodermal counterpart of the foregut. Around 22 days of embryonic period, diverticulum are develop, then between 26-28 days lung buds develop. The right bronchial buds and left bronchial buds are branched into secondary and tertiary buds at 5th and 6th week of embryonic life consecutively. During routine anatomy dissection and demonstration in the Department of Anatomy, a 50 year old male cadaver showed anatomical variation in the right lung. The present study observed that the right lung showed partial horizontal fissure. The reason for partial or incomplete fissure formation is due to incomplete or absence of obliteration of prenatal fissure which indicates partial fusion of lobes, generally fissures separating the broncho-pulmonary segments in prenatal life. The reports says that incomplete fissures of the lung may lead to spread of infection like pneumonia to adjacent lobe and collapse in endobronchial lesions and gradation of the fissures of the lungs are very important for lung surgeries. The present study concludes that the knowledge of anatomical variation of lung is of utmost important in the field of pulmonary medicine.

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

Background The 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 presentation We 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. Conclusion In 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.

Bilobed right lung: a case of absent horizontal fissure

The human lungs are organs of respiration present in the greater part of thoracic cavity on each side of heart in the mediastinum resting on diaphragm. The right lung is classically divided into three lobes namely superior, middle and inferior by the oblique and horizontal fissures. The left lung is divided into superior and inferior lobes by a single deep oblique fissure. The fissures help in expansion of lungs during respiration. During the routine dissection of thoracic region of human cadaver, bilobed right lung with absent horizontal fissure was observed. The right lung was divided into superior and inferior lobe by a single oblique fissure. The left lung had normal anatomy in this case. The variations in the fissures and lobar pattern of lungs are common and are due to altered developmental process during intrauterine life. The anatomical knowledge of these disparities in fissures is important for clinicians prior to performing any pulmonary surgical procedures and to prevent postoperative complications.

Migrating Pericardial Cyst Mimicking a Pleural Pseudotumor

We discuss an atypical presentation of a pericardial cyst appearing as a mobile lesion extending into and out of the right pulmonary major fissure. With the patient in the supine position, the cyst mimicked a pleural pseudotumor along the right oblique fissure. In the left lateral decubitus position, the cyst migrated to the right cardiophrenic angle and assumed an appearance more characteristic of a pericardial cyst. At surgery, a stalk was discovered attaching the cyst to the pericardium explaining its migrating nature. We conclude that computed tomography scanning in the decubitus position is useful for differentiating a mobile pericardial cyst from a pleural pseudotumor.

A Study on Morphological Variations of Fissures and Lobes of Human Lungs with its Clinical Significance

Background: Fissures of lungs facilitate the movement of lobes which helps in expansion of lungs during breathing. The fissures may be complete, incomplete or absence. Sometime the accessory fissures may also present. Awareness of variations is essential during segmental resections as well as during radiological interpretation of lungs. Hence, the present study was aimed to study the morphological variations in fissures and lobes. Material and Methods: This study was consisted of sixty nine human lungs with irrespective of sex which were available in the department of anatomy of various medical colleges. All lung specimens were carefully observed and recorded for the presence of any variations in fissures and lobes. Results: The present study revealed that the absence of horizontal fissure was observed in 7.89%, while no specimen showed absence of oblique fissure on both sides. 35.48% of left lungs had incomplete oblique fissure compared to 28.95% of the right lungs. In addition, 22.58% of right lungs and 23.68% of left lungs showed presence of accessory fissure and lobes. From above, the incomplete and absent horizontal fissure was the most common abnormalities observed in this study. The accessory fissures were more common in lower lobe of right lung whereas in left lungs it was more common in upper lobe. Conclusion: The present study showed the wide range of variations in fissures and lobes of lungs. The knowledge of variations in morphology of lungs would be helpful for clinical diagnosis and pulmonary surgical procedures.

Variations in the Morphology of Human Lungs and its Clinical Implications

Objective To observe variations in the fissures, in the lobes, and in the hilar pattern of lungs and correlate these findings with clinical implications. Materials and Methods The present study was performed on random lung specimens available in the Department of Anatomy. A total of 96 lungs (47 right and 49 left) were studied for variations in the fissures and lobes, and 92 lungs (45 right and 47 left) for variations in the hilar pattern. Results Among the right-sided lungs, 70% presented incomplete horizontal fissure, 15% with absence of the horizontal fissure, and 51% with incomplete oblique fissure. Accessory fissures were also seen, but incomplete, and accounted for 17% of the total number of right lungs.Among the left-sided lungs, 62% presented incomplete oblique fissures, and 4% with absence of the oblique fissure. Accessory fissures accounted for 6% of the total number of left lungs.Regarding hilar pattern variations, 11% of the right-sided lungs showed > 2 bronchi, 69% showed > 2 pulmonary veins, and 37% showed > 1 pulmonary artery.Among the left-sided lungs, 57% showed > 1 bronchi, 21% showed > 2 pulmonary veins, and 17% showed > 1 pulmonary artery. Conclusion The field of pulmonary surgery is now highly advanced, with well-developed radiological and endoscopic techniques. Hence, a proper understanding and knowledge of these morphological variations of lung fissures and of the hilar pattern would be advantageous for surgeons, as well as for radiologists.

Cadaveric Study of Lung Anatomy: A Surgical Overview

Background: Thorough knowledge of variations in lung anatomy is of prime significance during surgical procedures of lungs. Arrangement of structures in lung hilum act as a guide in performing such procedures. Normal pattern of arrangement of hilar structures in right lung is eparterial bronchus, pulmonary artery, hyparterial bronchus and pulmonary veins from above downwards. In left lung it is pulmonary artery, principal bronchus and pulmonary vein from above downwards. Arrangement of hilar structures from anterior to posterior in both lungs is pulmonary vein, pulmonary artery and principal bronchus. Aim: To report variations in hilar anatomy (arrangement and number) of lungs. Methods and Material: 75 adult formalin fixed cadaveric lungs from department of Anatomy AIIMS New Delhi were observed for variations in lobar anatomy. Arrangement of pulmonary hilar structures observed and variations recorded. Results: Among 75 adult lung specimens observed, 36 were right and rest left lung. Normal pattern of arrangement of hilar structures was seen in 22 right and 23 left lungs. Rest of the lung specimens (14 Right and 16 Left) showed variations in hilar anatomy. Some of them showed alterations in sequence of arrangement of pulmonary artery, pulmonary veins, bronchus and others in number of these structures. Seven right lung specimens showed only 2 lobes with an oblique fissure dividing them and one left lung showed 3 lobes. Conclusion: Alterations in pattern of arrangement of structures in lung hilum are quite frequent. A compromise in knowledge of such variations will result in inadvertent intraoperative complications.