How many lobes do you see?

Abstract

Accessory fissures represent a variation of the normal lung anatomy. Incomplete development or even the absence of the major or minor fissures can lead to confusion in distinguishing adjacent lobes. This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning.

Figure 1

Intraoperative image of the right lung. The patient lies in a left lateral decubitus position with his head on the right side of the image. The superior segment of the lower lobe appears as a separate lobe (white arrow).

Figure 2

Preoperative CT scan image of the patient (lung window) which shows the extend of bullous disease.