Variation of right B<sup>2</sup> downwards-shift: A special type of tracheal bronchus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zhili ¹ , ZHANG Min ² , LIU Xingyuan ¹ ,  GE Mingjian ²

1. Department of Thoracic Surgery, Chongqing University Jiangjin Hospital, Chongqing, 402260, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

GE Mingjian, Email: mingjian_ge@hospital.cqmu.edu.cn

Keywords：

Variation; lung; bronchi; vessel

DOI：

10.7507/1007-4848.202301012

Video：

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Objective To analyze and summarize the changes of the bronchus and vessels of right B² downwards-shift. Methods The 5 280 patients who underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2022 were screened. Based on the opening position of B¹⁺³, we classified bronchial variations into a normal type, over type, and tracheal-bronchus type. Results Finally 6 patients were included with 1 male and 5 females, aged 29 to 71 years. According to our bronchial classification, there were 4 (66.7%) patients of the normal type in this group, 1 (16.7%) of over type, and 1 (16.7%) of tracheal-bronchus type. About arteries, 4 (66.7%) patients was the trunk superior (Tr.sup)+posterior artery (A.post) type and 2 (33.3%) Tr.sup+trunk inferior (Tr.inf)+A.post type. About veins, 2 (33.3%) patients were the Ⅰab+right upper lobe vein posterior to the bronchus intermedius (UVPBI) type, 1 (16.7%)Ⅰb+UVPBI type, 1 (16.7%) anterior+UVPBI type, 1 (16.7%) central+UVPBI type and 1 (16.7%) central type. Conclusion In the right B² downwards-shift, A.post exists, and the posterior oblique fissure is poorly developed (RS² and RS⁶ are interconnected). Therefore, it is easier for us to dissect and disconnect B² intraoperatively, but it is necessary to be vigilant for vascular damage caused by opening the posterior oblique fissure.

Citation： LIU Zhili, ZHANG Min, LIU Xingyuan, GE Mingjian. Variation of right B² downwards-shift: A special type of tracheal bronchus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(12): 1759-1766. doi: 10.7507/1007-4848.202301012 Copy

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11.	Asai K, Urabe N, Yajima K, et al. Right upper lobe venous drainage posterior to the bronchus intermedius: Preoperative identification by computed tomography. Ann Thorac Surg, 2005, 79(6): 1866-1871.

1. Wooten C, Patel S, Cassidy L, et al. Variations of the tracheobronchial tree: Anatomical and clinical significance. Clin Anat, 2014, 27(8): 1223-1233.
2. Ghaye B, Szapiro D, Fanchamps JM, et al. Congenital bronchial abnormalities revisited. Radiographics, 2001, 21(1): 105-119.
3. Berrocal T, Madrid C, Novo S, et al. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: Embryology, radiology, and pathology. Radiographics, 2004, 24(1): e17.
4. Levin E, Bowling MR. Malignancy in the tracheal bronchus: A case series and review of the literature. Clin Respir J, 2018, 12(9): 2441-2445.
5. Xu XF, Chen L, Wu WB, et al. Thoracoscopic right posterior segmentectomy of a patient with anomalous bronchus and pulmonary vein. Ann Thorac Surg, 2014, 98(6): e127-e129.
6. Okubo K, Ueno Y, Isobe J. Upper sleeve lobectomy for lung cancer with tracheal bronchus. J Thorac Cardiovasc Surg, 2000, 120(5): 1011-1012.
7. Yaginuma H. Investigation of displaced bronchi using multidetector computed tomography: Associated abnormalities of lung lobulations, pulmonary arteries and veins. Gen Thorac Cardiovasc Surg, 2020, 68(4): 342-349.
8. Mehran RJ. Fundamental and practical aspects of airway anatomy: From glottis to segmental bronchus. Thorac Surg Clin, 2018, 28(2): 117-125.
9. Nagashima T, Shimizu K, Ohtaki Y, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg, 2015, 63(6): 354-360.
10. Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
11. Asai K, Urabe N, Yajima K, et al. Right upper lobe venous drainage posterior to the bronchus intermedius: Preoperative identification by computed tomography. Ann Thorac Surg, 2005, 79(6): 1866-1871.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Variation of right B² downwards-shift: A special type of tracheal bronchus

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Variation of right B2 downwards-shift: A special type of tracheal bronchus

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Variation of right B² downwards-shift: A special type of tracheal bronchus