Bronchial Branching Patterns and Volumetry in the Right Upper Lobe: Impact on Segmentectomy Planning

Segmentectomy is on the rise, but understanding of the segmental bronchial branching pattern is limited. Computed tomography scans of 303 patients were used to determine and categorize the branching of the right upper lobe bronchi. Four major types and eleven subtypes were identified. Volumetry was done to determine the predominant segment in each case. The order of frequency of branching types was trifurcated nondefective (64.4 percent), then bifurcated nondefective (22.1 percent), bifurcated defective (8.6 percent), and trifurcated half-defective (4.0 percent). In 71 percent of cases, one segment was volumetrically predominant, and in 52 percent of all cases this was segment three. There was a higher risk of complex branching in the volumetrically nonpredominant segment and care should be taken during segmentectomy of these segments.