Int J Anat Res 2014, 2(2):434-36. ISSN 2321-4287 434
Case Report
ACCESSORY FISSURE OF RIGHT LUNG: A REPORT OF TW O CASES
Sarita Behera *
1, Bijaya Kumar Dutta
2, M amata Sar
3.
ABSTRACT
Address for Correspondence: Dr. Sarita Behera, Senior Resident / Tut or, Depart ment of Anat omy, V.S.S.M edical College, Burla, Sambalpur, Odisha, India. Phone – 09937105198, 09437218699.
E-M ail: drsaritabehera81@gmail.com
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*1 Senior Resident / Tut or, 2 Professor, 3 Associate Professor.
Depart ment of Anat omy, V.S.S.M edical College, Burla, Sambalpur, Odisha, India.
Right lung is divided int o upper (superior), m iddle and low er (Inferior) lobes by an oblique and a horizontal fissure.Oblique f issure passes spirally f rom post erior border t o inferior border deep int o t he lung separat ing t he low er lobe from upper and m iddle lobes. A short horizontal fissure passes hor izont ally forw ards from t he oblique fissure at m idaxillary line t o m eet t he ant erior border at 4t h cost ochondral junct ion. This separat es t he upper lobe f rom t he m iddle lobe.Dur ing rout ine dissect ion in 2010-11 undergraduat e batch, w e cam e across t w o cases of right lungs w here an accessory f issure w as ext ending hor izont ally backw ards from t he oblique fissure at m id axi llar y line t ow ards t he vert ebral part of m edial surface. In t he 1st case, t his accessory fissure w as not m eet ing t he norm al horizontal fissure w here as in t he 2nd case it w as m eet ing. This accessory fissure separat es t he low er lobe int o a super ior and an inferior segm ent . Know ledge of different t ypes of accessory fissures is im por tant because it m ay m islead t he radiological findings, m ay act as a bar rier t o spread of infect ion creat ing a sharply m arginat ed pneum onia w hich can w rongly be int er pret at ed as at elect asis or consolidat ion. Ident ificat ion of com plet eness of fissure is im portant pr ior t o lobect omy, because individuals w it h incom plet e fissures are m ore prone t o develop post operat ive air leak.Considering t he clinical importance of such anom alies, anat om ical know ledge and pr ior aw areness of accessory fissures in t he lungs m ay be im portant for clinicians and radiologist s.
KEYW ORDS:Accessor y fissure of lung, Oblique fissure of lung, Horizontal fissure of lung.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research,
Int J Anat Res 2014, Vol 2(2):434-36. ISSN 2321- 4287
Received: 07 June 2014
Peer Review : 07 June 2014 Published (O):30 June 2014 Accepted: 18 June 2014 Published (P):30 June 2014 Internat ional Journal of Anat omy and Research
ISSN 2321-4287 w w w.ijmhr.org/ ijar.ht m
Right lung is divided int o upper (superior), middle and low er (Inferior) lobes by an oblique and a horizont al fissure [1]. Oblique fissure passes spirally from t he posterior border t o t he inferior border deep int o t he lung. This fissure separates t he low er lobe from upper and middle l ob es. A Sh o r t h o r i zo nt al f i ssu r e p asses horizontally forwards from t he oblique fissure at midaxillary line t o meet t he anterior border at 4t h cost ochondral junct ion, t hen backwards t o t he hilum on t he mediast inal surface [1]. This separates t he upper lobe from t he middle lobe.
EM BRYOLOGY
Defect ive pulmonary development gives rise t o variat ion in lobes and f issures. Fissures are spaces present bet w een bronchopulm onary segment s or buds in foetal life. Later on t hey get oblit erat ed except along t w o planes w hich persist aft er birt h as oblique and horizont al fissures. Non-oblit erat ion of som e of t hese spaces i s resp o nsi b le fo r t he p resen ce o f accessory fissures [2].
CASE REPORT
Int J Anat Res 2014, 2(2):434-36. ISSN 2321-4287 435 Sarit a Behera et al., ACCESSORY FISSURE OF RIGHT LUNG: A REPORT OF TW O CASES.
right lungs, w here t hree dist inct fissures w ere found instead of t w o. In each of t he t w o cases, t he posit ion & ext ent of oblique fissure w as normal, separat ing t he low er lobe from the rest . There was a normally placed horizontal fissure ext ending forw ards from t he oblique fissure separat ing a cuniform m iddle lobe from t he upper lobe.Apart from t hese t w o fissures, an
Fig. 1: Phot ograph of r ight l u n g sh o w i n g accesso r y fissure not m eet ing original hor izontal f issure.
Fig. 2: Phot ograph of r ight l u n g sh o w i n g accesso r y f i ssu r e m ee t i n g o r i gi n al hor izontal f issure.
Fig. 3: Photograph of both the r i gh t l u n gs sh o w i n g t h e accessory fissures.
Int J Anat Res 2014, 2(2):434-36. ISSN 2321-4287 436 Sarit a Behera et al., ACCESSORY FISSURE OF RIGHT LUNG: A REPORT OF TW O CASES.
DISCUSSION
Absence of one of t he fissures or presence of accessory fissures have earlier been reported by m any aut h o rs.Azygo s f i ssu r e (p ar t i al l y separat ing medial part of upper lobe i.e. lobe of t he azygo s v ein f ro m t h e rest ), sup er io r accessory fissure (separat ing t he apical segment of t he low er lobe from all t he basal segment s) and inferior accessory fissure (separat ing t he medial basal segment from rest of t he low er lobe) are t he common variant s [1]. We found superior accessory fissure in bot h t he cases as it was present in t he low er lobe separat ing t he apical segm ent from t he rest . Incidence of superior accessory fissure is found t o be 5-30% in aut opsy st udies w here as high resolut ion CT scan detect s it t o be 3% [3].M any a t ime, t he accessory fissures fail to be detected on CT scan, because of t heir incompleteness, t hick sect ions and orientat ion t o a part icular plane [4]. Furt her, superior accessory fissure is reported to be more common in right lung as compared t o left one w hich is consistent w it h our report s [3].
Know ledge of dif ferent t ypes of accessor y fissures is im port ant because it m ay help in clarifying t he confusing radiographic findings like ext ension of fluid int o an incom plet e m ajor fissure or spread of various diseases t hrough different pat hways [5]. It may act as a barrier t o sp read o f in f ect i o n, cr eat i ng a sh ar p l y marginated pneumonia w hich can w rongly be interpretated as atelectasis or consolidat ion [3]. Ident ificat ion of completeness of t he fissure is i m p o r t an t p r i or t o l o bect om y, b ecau se individuals w it h incomplete fissures are m ore prone t o develop post operat ive air leaks and may require furt her procedures such as stapling or pericardial sleeves [1, 6, 7].
CONCLUSION
Considering t he usefulness of t hese anomalies, clinicians and radiologist s should have t he anat omical know ledge and prior awareness of such accessory fissures in t he lungs.
Conflicts of Interests: None
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