anatomie chirurgicala pulmonara

8/9/2019 Anatomie chirurgicala pulmonara

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D IS E A S E S o f th e C H E S T

V O L U M E X X X IX JA N U A R Y , 1 96 1 N U M B E R 1

T h e N om encla tu re of

th e B ro nc ho pu lm on ary

S egm ents and T heir B loo d Su pp ly

(A s R e v ise d by the S ev en th In te rna tio na l C on gre ss o f A n ato m ists, 19 60 *)

E D W A R D A .

B O Y D E N ,

P h .D . (M ed . S c .)

S ea ttle , W ash in g to n

In th e su m m er

o f

1 94 9 , the In te rna tio na l C o ng ress o f O to -R h ino -L ar-

yn go log y , m e eting in L o nd on ,4 a do p ted n am es fo r th e b ro nc ho pu lm on ary

seg m e n ts w h ic h w e re b a se d la rge ly u po n th e te rm ino log y de v ise d b y

Ja ck son an d H ube r,’ an d u po n R . C . B ro ck ’s c lass ic al stud ies o f th e

a n ato m y of the b ron ch ia l tre e .5 T h is p re m ier ac c om plish m e n t by an in -

te rna tio na l g ro up ha s be e n o f g re at v a lue to a ll th ose w ho h av e h ad to

*M eetjn g in N ew Y ork C ity , A pril 10 -15 .

A ided b y resea rch gran t, H 25 47 , C ard iov ascu la r D iv is ion , U . S . P ub lic H ea lth S erv ice .

B R O N C H I

ronchus pr inc ip lis dex te r

et

sinister

r onch i lob res e t segm en t les

B R O N C H U S L O B A R IS S U P E R IO R D E X T E R

B ronchus segmen tal is apicalis

B ronch us seg m en ta lis po ste rio r

B ronch us segm enta lis an te rio r

B R O N C H U S L O B A R IS M E D IU S D E x T 1 5 R

B ronch us seg m en ta lis la te ra lis

B ronchus

segmental is

media l i s

B R O N C H U S L O B A R IS IN F E R IO R D E X T E R

B ronchu s segm enta lis ap ica lis [superio r]

(B ronchus segm en ta lis sub ap ica lis [sub sup er io r] ) t

B ronch us segm en ta lis b asa lis m ed ia lis E card iacus]

B ronchu s segm en ta lis basa lis an te rio r

B ronchu s segm enta lis basa lis la te ra lis

B ronchu s segm en ta lis ba sa lis p oste rio r

B R O N C H U S L O B A R IS S U P E R IO R S IN IS T E R

B ronch us segm enta lis ap ico pos te rio r

B ronch us segm enta lis an ter io r

B ronch us ling u la ris superio r

B ronchus

lingu lar is in fe rio r

B R O N C H U S L O B A R IS IN FE R IO R SIN IS T E R

B ronchu s segm en ta lis ap icalis [superio r ]

(B ron ch us segm enta lis subap ica lis [sub sup er io r])

B ronchu s segm enta lls basa lis m ed ia lis [ca rd iacu s]

B ronchu s seg m en ta lis basa lis an te rio r

B ronchu s segm enta lis b asa lis la te ra lls

B ronchu s segm enta lis basa lis p oste rio r

R am i bronch ia les segm ento ru m

B ronch io l i

B ronch io li resp irato r ii

D uc tu li a lv eo la res

S accu li alveo la res

A lveo li pu lm om s

Sq uare brack ets deno te o ffic ial a lte rna tives

f O va l b racke ts d esigna te an atom ica l varia tion s

C opy righ t 1 96 by the A merican C olle ge o f C hest P hys ic ians

1

Copyright © 1961 by American College of Chest Physicianson March 31, 2008chestjournal.orgDownloaded from

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3/8

p a r s

R a m. p o s t.K

p a r s

3 b

p a rs in tra s e g -----

3 b

p a rs in fro s e g . - -

R a m . a p ic . [s u p .]

p a rs in fra s e g .-

R a m . lo b i m e d ii - -- - .

p a rs lo t. -

a p i c .

---R a m . a n t.

s u p .

p a r s m e d .

R a m . b a s . a n t

p a r s i n t r a s e g .

p a rs in fra s e g .-

[ s u p . ]

inf.

9

1 0 b

IO o

R IG H T LUNG

FIG U R E 1 :

M aJor branches o f th e rig h t superio r and in f e rio r pu lm onary v ein s sup er-

im posed upo n the righ t bro nch ial tree. A rte rie s om itted . A ltho ugh the v e in s f o r

s e gmen t s 9 an d 1 0 hav e no t been nam ed b y the C ongress see f oo tno te to lis t o f v e in s ,

they hav e been draw n in th e f igure and com parab le nam es can be app lied to them if

needed .

2

ED W A R D A . B O Y D EN

Jan uary , 19 61

deal w ith th e anatom y o f the lung s. In 1949 , how ev er, no t enough w as

k n o w n

abou t the v ariatio ns in bronchial patte rn and in th e b lood supp ly

o f th e segm ents to so lv e all p rob lem s o f term ino logy . B ecause it w as

though t, f or in stan ce , that th e usual m ode o f branch ing o f th e basal

t runk

o f the le f t low er lobe w as a trif urcation , the C ongress om itted the

le f t m edial basal b ron chus. T h is has caused m uch conf u sion in hom o lo-

g iz in g th e segm ental d is tric ts o f rig h t and lef t low er lob es and th eir b lood

supply . S ince th en it h as b ecom e k n o w n th at in nearly f ou r-f i f ths o f lef t

lu ng s 110 spec im ens th e basal trun k d iv id es in to tw o stem s.’ T he f irs t

o f these f o rk s usually in to m edial basal and an terior basal bronch i, and

th e second in to lateral basal and po sterio r basal bronch i. Ind eed , the

le f t m edial basal m ay arise alone , as th e f irs t b ran ch o f th e basal bron-

chus, in as h igh as 33 per cen t o f lu ngs.’

A l s o ,

in

1949 , it

w as no t

po ssib le to nam e accurate ly either the seg -

m en tal arte rie s o r the prin cipal v e ins th at drain th e segm en ts . T he f irs t




4/8

Ia

2b

lb

3 b

R am . lin g .

R am . a p ic [s u p .

V . b a s .

V . b a s . in f.

70

lO o

Vo l. X X XIX NOM EN CLATURE OF B RON CHOPULMON ARY SEGM ENTS

3

FIGURE 2 : MaJor branches o f the le ft superio r and inferior pulmonary ve ins super-

impo sed upon the le ft bronchial tree . A rterie s om itted.

Se e

note in legend o f Fig . 1 .

step in this direc tion w as taken by the Fifth International Congress o f

A natomists meeting at Ox ford U niv ers ity in 1950 . There, an Interna-

tional A natom ical N omenc lature Comm ittee IA N C w as appointed for

the purpose o f reaching agreement on the term s used in Gro ss Human

A natomy . It w as hoped that this w ould end div is iv e nationalis tic vers ions

o f anatomical terms w hich had sprouted up during the y ears be tw een

the tw o W orld W ars . This committee under the guidance of Pro fe ssor

Georg e W . Corner o f B altimore Chairman and Profe sso r T. B . John-

ston of Guy’s Hospital Honorary Secre tary w as instruc ted to prepare

a rev is ion of anatom ical terms that should be based upon the orig inal

B N A 1895 . In 1955 , this rev is ion N OM IN A A N A TOM ICA 9 w as ac -

cepted by the S ix th International Congress o f A natom ists mee ting in

Paris. It contained not only the names of the segmental bronchi and

bronchopulmonary segments but also the names of the principal arterie s

supply ing these segments . Little more w as done about the v enous drain-

ag e than to des ignate intersegmental ve ins under such g eneral terms

as superior, m edial , lateral and inferior-term s w hich failed to identify

spec ific intersegmental v eins ,

and

omitted o thers o f importance . A ccord-

ing ly , the Comm ittee of the S ev enth Congress, headed by Pro fe sso r Cor-

ner Chairman and Pro fe sso r G . A . G. M itche ll o f M anchester Honor-

ary Secre tary c ame to grips w ith this problem , among o thers .

LE FT LUN G

R a m . o p ic o p o s t.

p a rs in tro s eg .

p a rs in fra se g.

R am . a n t.

p a rs In tro s e g .

3 b p a rs in fro s e g .

b R a m . lin g .

p a rs s up e rio r

p a rs in fe rio r

b o s . a n t.

‘p a rs in tra s e g .

p a rs in fra se g.




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V o l . X X X I X N O M E N C L A T U R E O F B R O N C H O P U L M O N A R Y S E G M E N T S 5

P ro fesso r C o rd ie r an d D r. C a bro l o f P aris .6 In s truc tiv e as the se m o no -

g ra ph s a re to sp ec ia lis ts in the fie ld it h as b ec om e c lea r tha t som e sim p le r

sys te m m ust be d ev ised tha t re la te s the p rim a ry b ra nc he s o f the fou r

p u lm on ary v eins (o r the ir m a jo r d iv is ion s) to g iv en se gm en ts . T he

sch em e d esc rib ed b e low (F igs . 1 a nd 2) w a s th e on e ad op te d by the

C ongre s s .

In g en era l, it a pp lie s th e se gm e n ta l n am e to tha t ra m u s o f a p u l-

m on ary ve in w h ich is c lo sely a sso cia te d at th e h ilum w ith the b ro nc hu s

o f th at seg m en t a nd w hic h c om m o nly rec e ive s tw o m a jo r tribu tarie s

from tha t seg m e n t-na m e ly o ne from its in te rio r (a pa rs intra se gme n-

tails , a n d o ne from its in fer io r surface

(a

p ars i nfra se gm en ta li s . U sua l-

ly , the la tte r is in te rseg m e n ta l; so i t is pe rm iss ib le to su bs titu te tha t

V E N A E

P U L M O N A L E S

V. pulmona lis dextra

V . pu lm on a lis sup erio r dex tra

R am us ap ica lis

P ar s i nt ra se gm e nt al is

P ars in fraseg m en ta lis [in te rsegm entalis ]

R am us an te rio r

P ar s i nt ra se gm e nta li s

P ars in frasegm entalis [in te rsegm entalis ]

R am us pos te rio r

P ars in fra lo ba ris

P ars in tra lobaris [in te rsegm entalis ]

R am us lo b i m ed ii

P ars la te ra lis

P ars m e dia lis

V . pu lm ona lis in fe rio r dex tra

R am u s ap ica lis [superio r]

P ar s i nt ra se gm e nta li s

P ars in frasegm enta lis [in tersegm enta lis ]

V . b asa lis com m un is

V . basa lis sup er io r

R am us basa lis an ter io r6


Pars in frasegm enta lis [in te rsegm enta lis ]

V . basa lis in fe rio r

V . pulmona lis sinistra

V . pulm o nalis supe rio r sinistra

R am us ap ico pos te rio r


P ars in fraseg m en ta lis [in te rseg m en ta lls]

R am u s an terio r

P ar s in tr as eg m en ta lis

P ars in frasegm enta lis [in te rsegm enta lis]

R am us lin gu la ris

P ars sup er io r

P ars in fe rio r

V . pu lm ona lis in fe rio r s in is tra

R am us ap ica lis [sup er io r]

P ars in tras egm en talis

Pars in frasegm enta lis [in te rsegm enta lis]

V . b asa lis com m u nis

V . basa lis superio r

R am us basa lis an ter io r6


P ars in fraseg m en talis [in te rseg m en talis]

V . basa lis in ferio r

*

O n ly th e large ve ins re la ted to an te rio r basa l an d m edia l basa l seg m en t s are g iven

since o th er basa l segm ents a re resec ted ra re ly .




7/8

6

E D W A R D A . B O Y D E N

Jan Y , 19 61

na m e. A se em ing ex ce p tion to th is pa tte rn is p re se n ted b y th e pos te rio r

ve in o f th e rig h t up pe r lob e. H ere th e tw o m ajo r tribu ta ries are (1 ) the

larg e v ein run n in g be ne a th the su rfac e o f the pos te rio r se gm e n t in the

in te rlo ba r fissu re a nd (2 ) the v ein w h ic h jo in s it th ere , after em e rg in g

from the c en ter o f th e lo be b etw e en a n te rio r an d po s terio r seg m e n ts.

H e nc e , the se

tw o trib uta ries

ha ve b ee n na m ed , resp ec tiv ely , the pars

infralobaris

a nd th e

pa rs intra lo ba ris o f

th e

ramus posterior. T he s e

ar e

im p orta n t b ra nc he s , c lin ica lly , s in ce e ithe r o f th ese v eins m ay be ab sen t

c on ge n ita lly an d it s dra ina ge be tak en o ve r by th e su rv iv ing v ein . If th e

in fra lob ar d iv ision d rop s o u t, th e a sce nd in g a rterie s to the lo be a re e x -

po sed (the a rteria l ty pe o f A pp le ton );’ if the in tra lob ar d iv is io n d rops

out,

th e

arte ries are co ncea led

by the

en larged in fra lo bar

d iv is ion (th e

v en ou s ty pe o f A p p le ton ).’

In o rde r to fa c ilita te u nd ers ta nd ing o f th ese p a ttern s , d ia g ra m s o f

th e ve ins a n d assoc ia ted b ro nc h i a re p rese n ted (F ig s. 1 a nd 2) w itho u t

th e c om plic a ting

presen ce of arte ries .

T he b ron ch i h av e be en n um be re d

ac co rd ing to the o rd er a do p te d by the 19 55 C on gre ss. F o r the righ t up pe r

lob e: a p ic al (1 ), po ste rio r (2 ), a n terio r (3 ); fo r the m ed ia l lob e: la tera l

(4 ), m ed ia l (5 ); fo r th e rig h t low er lo be : a p ic a l [sup erio r] (6 ), m ed ia l

ba sal [ca rd iac ] (7 ),

anter ior

ba sa l (8 ), la te ra l ba sal (9 ), p os te rio r ba sal

(10 ) .

H om olog ou s nu m b ers h ave

be en ap p lied to th e left lun g .

In c on clu s ion , it m a y b e s ta ted a ga in th at th e ob je ctive o f the

Congre s s

in de al ing w ith th e ve ins o f the lu ngs h as be en to sett le upo n s im p le

se lf-e xp lan a to ry te rm s . A lth ou gh th e in te rna tio na l lan gu ag e o f an atom y

is L a tin , th e

vernacu lar m ay

be su bs titu te d fo r lo ca l u sag e.

R E F E R E N C E S

1 A p ple to n , A . B .: “T he A rte ries an d V ei n s of the L u ngs . I. R igh t U pper L ob e.”

Journ. Ana t., 79 :97 ,

1945 .

2 B o yden , E . A .:

Segmenta l Anatomy of the Lungs,

B lak iston D iv is ion , M cG raw -H ill

C o ., N ew Y ork , 1955 .

3 B o yden , E . A ., and T om p se tt, D . H .: “A nom alou s S p litting o f th e U p per L obe

B ro nchus in R igh t and L ef t L ungs ; W ith a N ote on the In c id en ce In the L ondo n

A rea of L ef t M edia l B asa l Segm ents ,” J. Thor. Surg ., 37 :46 0 , 195 9 .

4 B ro ck . R . C .: “T h e N om en cla tu re o f B ron ch o-pu lm o nary A natom y. A n In te rn a-

tio na l N om enc la tu re A ccep ted by th e T h orac ic S oc ie ty ,” Thorax, 5 :22 2 , 195 0 .

5 B ro ck , R . C .: The Anatomy of the Bronchia l Tree , O xford U nivers ity P ress, N ew

Y o rk , 194 6 (2n d E d . 1954 ).

6 C o rd ie r, G . J., et C ab ro l, C .: “L es P { 2 3 3 } d .t c u le s S e g m e n t ai r e s du P oum on . T om e I,

P o u m o n D r o i t (1 952) ; T o m e II, Pou m on G au ch e (195 5) ,“ Expa nsion Sc ientifique

Fran Qaise , Par is .

7 G om ez-O llve ros , L .: “V eins of the L un gs,” Acta Salamanticensia Medic ina , T o m o

IV ,

n { 2 5 2 } m .

, Sa lam anca, 1 959 .

8 Jackson , C . L ., and H uber, J . F .: “C orre la ted A p plied A natom y of the B ronch ia l

T r ee an d L u n g s w ith a Sy stem of N om en cla tu re ,”

Dis .

Chest, 9 :3 19 , 1943 .

9

N O M IN A A N A T O M IC A :

W i l l i am s and W ilk ins, B a ltim ore , 1 956 .




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DOI 10.1378/chest.39.1.11961;39;1-6Chest

EDWARD A. BOYDEN1960)

Supply: (As Revised by the Seventh International Congress of Anatomists,The Nomenclature of the Bronchopulmonary Segments and Their Blood

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anatomie chirurgicala pulmonara

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