Lingular division of the left lung: Only superior and inferior bronchi?

The lingular segment bronchi usually bifurcate into superior lingular (B⁴ ) and inferior lingular (B⁵ ) segmental bronchi. We report 32 horizontally bifurcated lingular segment bronchi cases, analyzing the bronchovascular variations and the perioperative outcomes. All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2022. The bronchovascular patterns were analyzed for each patient. A consecutive 5280 patients were included, and 32 cases of this malformation were identified. The incidence of the lateral (B⁴ ) and medial (B⁵ ) lingular segmental bronchi is 0.6%. The A⁴ and A⁵ arise separately in 21 (65.6%) patients. In 9 (28.1%) patients, the A⁴ a arises from the common trunk of A^4 + 5 . In 2 (6.3%) patients, the A⁴ arises from the interlobe artery, while A⁵ is a mediastinal lingular artery. The common trunk of V⁴ a + b is found in 19 (59.4%) patients. The V⁵ is the least changeable of the segmental bronchi veins. Among the 32 patients, five patients had an LS⁴ segmentectomy. The surgical details of the five patients are summarized. The laterally and medially bifurcated lingular bronchus pattern is a rare anomaly. It implies that the lingular bronchus is not only superiorly and inferiorly bifurcated.