Pulmonary vein analysis using three-dimensional computed tomography angiography for thoracic surgery

Little information is available regarding the variations in pulmonary vein anatomy for the purpose of thoracic or video-assisted thoracoscopic surgery (VATS). To learn about the types and frequency of pulmonary vein variations for VATS, we reviewed a "tailor-made virtual lung" of patients that was constructed using three-dimensional multidetector computed tomography (3D-MDCT) angiography.

We reviewed routine 64-row 3D-MDCT pulmonary angiography of 140 patients before surgery between June 2006 and February 2009.

We observed that most patients had the expected anatomy (98%) on the left side and on the right side (86%). On the right side, 10% of patients had three branches, and 4% patients had four or five branches. Independent drainage of the middle lobe vein directly into the left atrium was observed in 8% patients. Common ostia were observed on the left side in 33% and on the right side in 13% of the patients. The right inferior pulmonary veins branched immediately in 23% of the patients. Right isolated superior posterior branches were observed occasionally (2%).

We observed common ostia more frequently on the left side than on the right. The middle lobe variations were frequent, and the right inferior pulmonary vein often divided at the root. Preoperative 3D-MDCT presented correct pulmonary vein anatomy of the patients.