(1)
IMM, Curie-Montsouris Thorax Institute, Paris, France
Electronic Supplementary Material
The online version of this chapter (doi:10.1007/978-3-319-55901-8_4) contains supplementary material, which is available to authorized users.
4.1 Anatomical Landmarks (◘ Fig. 4.1)
Fig. 4.1
Anatomical landmarks. a Middle lobe bronchus (lateral view), b arterial supply to the middle lobe with a single and large artery, c arterial supply to the middle lobe with a single artery branching early in lateral and medial arteries (lateral view), d arterial supply to the middle lobe with two separate arteries (lateral and medial) (lateral view), e venous drainage with a single vein (posterior view), f venous drainage with two veins (posterior view)
Bronchus
The middle lobe bronchus lies in a groove between the two segmental arteries. It branches into two segmental bronchi that are usually not seen during a middle lobectomy (◘ Fig. 4.1a).
Arteries
There are three different patterns:
One single and large artery in half of the patients, (A4+5) originating from the anterior surface of the pulmonary artery, opposite to the ascending posterior branch (Asc.A2) to the upper lobe (◘ Fig. 4.1b)
One single artery with early division in two branches (◘ Fig. 4.1c)
Two arteries arising separately from the pulmonary artery in the fissure: the lateral segmental artery (A4) whose origin is just below the confluence of the oblique and transverse fissure, opposite to the superior segmental artery, and the medial artery (A5) which lies deeper and is hidden by the lobar bronchus (◘ Fig. 4.1d)
Vein
The middle lobe vein is the inferior root of the superior pulmonary vein and is the most anterior element. It can be single (V4+5) or double (◘ Fig. 4.1e and f). Early division of the vein(s) facilitates the access to the bronchus.
4.2 Anatomical Variations and Pitfalls (◘ Fig. 4.2)
The middle lobe artery, when highly located, must not be confused with an ascending artery to segment 3 (Asc.A3) (◘ Fig. 4.2a).
Fig. 4.2
Anatomical variations and pitfalls. a An ascending artery to the anterior segment of the upper lobe (Asc.A3) must not be confused with the middle lobe artery; b the middle lobe vein can branch from the inferior pulmonary vein
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