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Right upper lobe anatomy revisited: a computed tomography scan study.
Jean S Bussières1,2, Michel Gingras3, Lindsay Perron4
1Department of Anesthesiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada. jbuss@criucpq.ulaval.ca.
Summary
This study measured right main stem bronchus (RMSB) length and right upper lobe bronchus (RULB) angulation using CT scans. Findings improve understanding of bronchial anatomy for thoracic surgery lung isolation.
Area of Science:
- Thoracic surgery
- Anesthesiology
- Medical imaging
Background:
- Double lumen tubes (DLTs) are standard for lung isolation in thoracic surgery.
- Right-sided DLTs (R-DLTs) are less favored due to variable right main stem bronchus (RMSB) anatomy.
- Challenges include RMSB length and right upper lobe bronchus (RULB) orifice misalignment.
Purpose of the Study:
- To validate an alternative method for estimating RMSB length.
- To determine the distribution of RULB ostium angulation.
- To enhance understanding of right bronchial tree anatomy for improved lung isolation device selection.
Main Methods:
- High-resolution computed tomography (CT) scans from 106 patients were analyzed.
- RMSB length was measured using Kim's method and a carina-to-carina method.
- RULB origin angle relative to the RMSB was measured; inter-observer variation was assessed.
Main Results:
- Mean RMSB length: Kim's method 25.5 mm, carina-to-carina method 29.4 mm.
- Both methods showed substantial inter-observer agreement (ICC = 0.84 and 0.95, respectively).
- RULB angulation exhibited wide variation (mean 0.1°, range -28.6° to 21.2°).
Conclusions:
- Anatomical variations in the right bronchial tree are significant.
- Measurements provide insights into RMSB length and RULB angulation.
- Findings can guide thoracic anesthesiologists in selecting appropriate lung isolation devices.
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