Right middle pulmonary vein classification by 3D-CT reconstruction and its clinical significance

Wenwei Wei; Hang Zhou; Hao He; Hui Lin; Yasmeen K Tandon; Timothy J Jaykel; Xiaofeng Chen; Pei-Yuan Wang; Shuo-Yan Liu; Feng Wang

doi:10.21037/jtd-23-1560

Right middle pulmonary vein classification by 3D-CT reconstruction and its clinical significance

J Thorac Dis. 2023 Dec 30;15(12):6868-6878. doi: 10.21037/jtd-23-1560. Epub 2023 Dec 14.

Authors

Wenwei Wei^#^{1

2

3}, Hang Zhou^#¹, Hao He^#¹, Hui Lin¹, Yasmeen K Tandon⁴, Timothy J Jaykel⁴, Xiaofeng Chen¹, Pei-Yuan Wang¹, Shuo-Yan Liu¹, Feng Wang¹

Affiliations

¹ Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China.
² Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
³ Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China.
⁴ Department of Radiology, Mayo Clinic, Rochester, MN, USA.

^# Contributed equally.

Abstract

Background: A profound understanding of the type of right middle lobe (RML) vein return is crucial for thoracic surgeons to ensure safe anatomic lung resection. In this study, the type of venous return in the RML and its clinical significance were analyzed using the 3D computed tomography (3D-CT) reconstruction technique.

Methods: This retrospective study analyzed the patients who underwent anatomical lobectomy or anatomical lung segment resection with preoperative 3D-CT reconstruction at the Department of Thoracic Oncology Surgery, Fujian Cancer Hospital from January 2020 to October 2022. The exclusion criteria were as follows: (I) blurred CT images and inadequate IQQA 3D reconstruction for clear visualization of bronchial and vascular subsegmental branches; (II) patients with a previous history of right middle lobectomy; (III) incomplete medical records.

Results: This study included 608 eligible cases, 245 males (40.30%) and 363 females (59.70%), with an average age of 58.61 years. We identified four major types of RML venous return, including 407 cases (66.94%) of central vein type, 123 cases (20.23%) of isolated vein type, 11 cases (1.81%) of basal vein type, and 67 cases (11.02%) of combined vein type. Furthermore, the central venous type comprised four subtypes: 191 cases (27.3%) had one branch, 165 cases (27.14%) had two branches, 43 cases (7.07%) had three branches, and 8 cases (1.32%) had more than three branches. The combined venous type includes four subtypes: combination type A (n=37 cases, 6.09%), combination type B (n=7 cases, 1.15%), combination type C (n=21 cases, 3.45%), and combination type D (n=2 cases, 0.33%).

Conclusions: Based on 3D-CT reconstruction, numerous types of venous return in the RML were found, highlighting the significance of 3D-CT reconstruction for thoracic surgeons. It plays a crucial role in understanding the type of RML venous return prior to surgery, providing invaluable information to ensure surgical safety and success.

Keywords: 3D computed tomography (3D-CT); Right middle lobe (RML); venous return.