Subscribe to RSS
DOI: 10.1055/s-0041-1741045
Study on Anatomical Variations in Fissures of Lung by CT Scan
Abstract
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.
Financial Support and Sponsorship
Nil.
Publication History
Article published online:
11 January 2022
© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Sadler TW. Langman's Medical Embryology. 11th ed.. Baltimore, Maryland: Lippincott Williams & Wilkins; 2004: 203-205
- 2 Magadum A, Dixit D, Bhimalli S. Fissures and lobes of lung – an anatomical study and its clinical significance. Int J Curr Res Rev 2015; 7: 8-12
- 3 Tarver RD. How common are incomplete pulmonary fissures, and what is their clinical significance?. AJR Am J Roentgenol 1995; 164 (03) 761
- 4 Cronin P, Gross BH, Kelly AM, Patel S, Kazerooni EA, Carlos RC. Normal and accessory fissures of the lung: evaluation with contiguous volumetric thin-section multidetector CT. Eur J Radiol 2010; 75 (02) e1-e8
- 5 Craig SR, Walker WS. A proposed anatomical classification of the pulmonary fissures. J R Coll Surg Edinb 1997; 42 (04) 233-234
- 6 Mamatha Y, Murthy CK, Prakash BS. Study of morphological variations of fissures and lobes of lung. Int J Anat Res 2016; 4: 1874-1877
- 7 Arora AK, Verma P, Kullar JS, Sharma RK, Singla R, Mahajan A. Variations of fissures of lungs. Rev Argde Anat Clin 2012; 4: 50-56
- 8 Meenakshi S, Manjunath KY, Balasubramanyam V. Morphological variations of the lung fissures and lobes. Indian J Chest Dis Allied Sci 2004; 46 (03) 179-182
- 9 Prakash, Bhardwaj AK, Sashirekha M, Suma HY, Krishna GG, Singh G. Lung morphology: a cadaveric study in Indian population. Ital J Anat Embryol 2010; 115: 235-240
- 10 Bhimai Devi N, Narasinga Rao B, Sunitha V. Morphological variations of lung-a cadaveric study in north coastal Andhra Pradesh. Int J Biol Med Res 2011; 2: 1149-1152
- 11 Jacob SM, Pillay M. Variations in the inter-lobar fissures of lungs obtained from cadavers of South Indian origin. Int J Morphol 2013; 31: 497-499
- 12 George BM, Nayak SB, Marpalli S. Morphological variations of the lungs: a study conducted on Indian cadavers. Anat Cell Biol 2014; 47 (04) 253-258
- 13 Ariyürek OM, Gülsün M, Demirkazik FB. Accessory fissures of the lung: evaluation by high-resolution computed tomography. Eur Radiol 2001; 11 (12) 2449-2453
- 14 Gülsün M, Ariyürek OM, Cömert RB, Karabulut N. Variability of the pulmonary oblique fissures presented by high-resolution computed tomography. Surg Radiol Anat 2006; 28 (03) 293-299
- 15 Proto AV, Ball Jr JB. Computed tomography of the major and minor fissures. AJR Am J Roentgenol 1983; 140 (03) 439-448
- 16 Yildiz A, Gölpinar F, Calikoğlu M, Duce MN, Ozer C, Apaydin FD. HRCT evaluation of the accessory fissures of the lung. Eur J Radiol 2004; 49 (03) 245-249
- 17 Heřmanová Z, Ctvrtlík F, Heřman M. Incomplete and accessory fissures of the lung evaluated by high-resolution computed tomography. Eur J Radiol 2014; 83 (03) 595-599
- 18 Aziz A, Ashizawa K, Nagaoki K, Hayashi K. High resolution CT anatomy of the pulmonary fissures. J Thorac Imaging 2004; 19 (03) 186-191
- 19 Mahmut M, Nishitani H. Evaluation of pulmonary lobe variations using multidetector row computed tomography. J Comput Assist Tomogr 2007; 31 (06) 956-960
- 20 Raasch BN, Carsky EW, Lane EJ, O'Callaghan JP, Heitzman ER. Radiographic anatomy of the interlobar fissures: a study of 100 specimens. AJR Am J Roentgenol 1982; 138 (06) 1043-1049
- 21 Hayashi K, Aziz A, Ashizawa K, Hayashi H, Nagaoki K, Otsuji H. Radiographic and CT appearances of the major fissures. Radiographics 2001; 21 (04) 861-874
- 22 Berkmen YM, Auh YH, Davis SD, Kazam E. Anatomy of the minor fissure: evaluation with thin-section CT. Radiology 1989; 170 (3 Pt 1): 647-651
- 23 Lukose R, Paul S. Sunitha, et al. Morphology of the lungs: variations in the lobes and fissures. Biomedicine 1999; 19: 227-232
- 24 Frija J, Schmit P, Katz M, Vadrot D, Laval-Jeantet M. Computed tomography of the pulmonary fissures: normal anatomy. J Comput Assist Tomogr 1982; 6 (06) 1069-1074
- 25 Webb R, Higgins CB. The pleura and pleural disease (Ch-26). In: Thoracic Imaging: Pulmonary and Cardiovascular Radiology. 2nd ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 616-634
- 26 Criner GJ, Cordova F, Sternberg AL, Martinez FJ. The National Emphysema Treatment Trial (NETT) Part II: lessons learned about lung volume reduction surgery. Am J Respir Crit Care Med 2011; 184 (08) 881-893
- 27 Gómez-Caro A, Calvo MJ, Lanzas JT, Chau R, Cascales P, Parrilla P. The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg 2007; 31 (02) 203-208
- 28 Felson B. The azygos lobe: its variation in health and disease. Semin Roentgenol 1989; 24 (01) 56-66
- 29 Caceres J, Mata JM, Andreu J. The azygos lobe: normal variants that may simulate disease. Eur J Radiol 1998; 27 (01) 15-20
- 30 Villanueva A, Cáceres J, Ferreira M, Broncano J, Pallisa E, Bastarrika G. Migrating azygos vein and vanishing azygos lobe: MDCT findings. AJR Am J Roentgenol 2010; 194 (03) 599-603
- 31 Patil SJ. Azygos lobe –a review. Int J Clin Surg Adv 2013; 1: 17-19
- 32 Calhoun PS, Kuszyk BS, Heath DG, Carley JC, Fishman EK. Three-dimensional volume rendering of spiral CT data: theory and method. Radiographics 1999; 19 (03) 745-764