Potentially overlooked branches of the left pulmonary artery

During pulmonary resection, we sometimes encounter "pitfall branches" of the pulmonary artery, which could cause serious vessel injury. Current computed tomography and computer-processing technology can identify the pulmonary artery along the peripheral bronchus, thereby revealing the true rates of different pulmonary artery branching patterns. Knowledge of these branching patterns allows safe and definitive surgery.

In 186 cases of left lung resection performed at our institution from January 2006 to September 2011, two general thoracic surgeons and one radiologist independently reviewed computed tomography images and examined the branches of the pulmonary artery arising from the pars mediastinalis.

Branching patterns of the lingular artery included 17 (9.2%) cases with mediastinal origin, 50 (26.9%) with interlobar and mediastinal origin, and 119 (63.9%) with interlobar origin. The 2 types of lingular artery of mediastinal origin, which were potentially overlooked during surgery, were observed in 36.1% of cases. This was a higher rate than previously reported. Moreover, a mediastinal basal pulmonary artery (A(5+8+10) abnormal branching) was seen in one case.

Potentially overlooked branches of the left pulmonary artery arising from the pars mediastinalis are much more frequent than we expected. It is crucial to understand the branching pattern of the pulmonary artery by preoperative computed tomography assessment.