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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2702_Библиотеки_им_академика_М_И_Перельмана
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caudal
cranial
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112
Left B6c
B6b
B6c
2 Actual Identication ofBronchial Branch
6
a
B
B6c
6
b
caudal
B
6
a
B
B6ci
B6ci a
B6c
B6ci
6
B
B6ci b
6
b
B
B6c
mediallateral
6
B
c
6
a
B
cranial
6
a
B
6
B
b
cii
6
ci
B
6
ci
B
6
B
6
ci a
B
ci b
6
B
cii
6
B
cii
B6ci a
Fig. 2.168 CT, bronchial branch diagram and bronchoscopic ndings
B6cii
6
b
B
6
ci
6
B
a
B
6
ci
B
2 Actual Identication ofBronchial Branch
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113
Fig. 2.171 Fluoroscopy (2)
Fig. 2.169 Fluoroscopy (1)
Fig. 2.170 EBUS
A biopsy is performed with the biopsy forceps through the
guide sheath that reaches the lesion on the X-ray uoroscopic screen (Fig.2.187).
Left B9b (Figs. 2.188, 2.189, 2.190 and 2.191).
Follow the reversed CT images from the cranial side to the
caudal side. The left lower lobe bronchus branches into B6
in the dorsal and lateral directions. The left truncus basalis branches into B8+B9 and B10. B9 branches into B9b in
the caudal direction and B9a in the lateral and dorsal
directions.
B9b branches into B9bi in the dorsal and lateral directions
and B9bii in the ventral and medial directions. B9bi
branches into B9biα in the lateral direction and B9biβ in
the medial direction. B9biα branches into B9biαx in the
dorsal and lateral directions and B9biαy in the caudal
direction. B9biαy branches into B9biαyy in the ventral and
medial directions and B9biαyx on the dorsal and lateral
directions. B9biαyx enters the lesion (Fig.2.188).
Fig. 2.172 Bronchial
anatomy in the left basal
segment
114
B
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Fig. 2.173 Typical branching
of the left basal segment
bronchus
2 Actual Identication ofBronchial Branch
6
B
6
a
B
6
c
10
a
B
10
B
B6b
8
a
B
8
9
a
B
8
B
8
b
B
c
9
10
b
B
B
b
b
9
B
a
a
B
9
B
b
a
6
c
B
6
b
B
10
B
a
10
c
B
10
b
B
front view lateral view
ventral
B8b
B8a
B9b
B9a
B10b
lateral
B10c
medial
B10a
6
B
dorsal
Fig. 2.174 Bronchoscopic ndings in the left lower lobe bronchus
cranial
cranial
caudal
caudal
2 Actual Identication ofBronchial Branch
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Left B8a
6
B
truncus basalis
115
B8a
8
B
B8aii
ai
ventral
B8b
8
ai
B
B8ai
B8ai b
8
B
ai a
lateral
9+B10
B
6
B
B
8
B
B9+B
8
10
dorsal
B8b
8
aii
B
medial
B
B8ai
8
aiax
B8ai
B8aiay
8
B
aii
b
B8aiaxy
8
aiaxx
8
B
aii
B
Rotate the bronchoscope
clockwise 90°
B8aiaxx
B8ai a
B8ai ay
B8ai ax
8
B
ai axy
B8ai a xx
Fig. 2.175 CT, bronchial branch diagram and bronchoscopic ndings
8
aiaxy
B
8
B
aiax
8
B
aiaxx
B
B8ai
8
B
aib
8
B
8
aii
8
B
aiay
b
bronchoscope clockwise 90°
B8aiaxx
In addition, rotate the
B8aiaxx
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Fig. 2.176 Fluoroscopy
2 Actual Identication ofBronchial Branch
On the uoroscopic screen, the ultrasonic probe inserted into
B9biαy reached the lesion (Fig.2.189).
The probe inserted into B9biαy could reach within the lesion
(“within”). As the internal echo is heterogeneous, with
few hyperechoic lines inside the lesion, it is diagnosed as
type IIIb (Fig.2.190).
On the X-ray uoroscopic screen, the biopsy forceps are
inserted through the guide sheath that reached the lesion
and then closed at the lesion (Fig.2.191).
Left B10b (Figs. 2.192, 2.193 and 2.194)
Follow the reversed CT images from the cranial side to the
caudal side. The left truncus basalis branches into B6 in
the dorsal and lateral directions. The left basal bronchus
branches into B8 and B9+B10. B9+B10 branches into the
subsuperior bronchus (B∗) in the lateral direction and B9
and B10 in the caudal direction (see B∗ on page 61).
After B
∗
branches out, B10 further branches into B10a in the
dorsal direction, B10b in the lateral direction, and B10c in
the medial direction. B10b branches into B10bi in the dorsal and lateral directions and B10bii in the ventral and
medial directions. B10bii branches into B10biiα in the dorsal direction and B10biiβ in the ventral direction. B10biiα
branches into B10biiαx in the dorsal and lateral directions
and B10biiαy in the ventral and lateral directions. B10biiαx
enters the lesion (Fig.2.192).
Fig. 2.177 EBUS
The ultrasound probe is inserted into B10biiα and reaches the
lesion on the uoroscopic screen (Fig.2.193).
When inserting the probe into B10biiα, the probe could reach
the margin of the lesion (“adjacent to”). Of note, hyperechoic lines are found inside the lesion (Fig.2.194).
cranial
caudal
2 Actual Identication ofBronchial Branch
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Left B8b
lower lobe br.
ventral
B9+B
117
10
B8bib
8
B
B
b
mediallateral
9+B10
B8a
6
B
8
B
truncus
basalis
6
B
dorsal
8
B
B9+B
10
8
bii
B
B8b
8
B
a
B8biax
B8bib
B8b
8
a
B
B8bi
B8bii
8
B
bi
8
a
B
8
B
bii
B8bib
8
bia
B
B8biax
8
biay
B
B8biax
B8bi ax
B8bi ax
Fig. 2.178 CT, bronchial branch diagram and bronchoscopic ndings
8
bia
9+B10
B
6
B
B
8
B
biay
B8biax
Rotate the bronchoscope
counterclockwise
B8biax
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2 Actual Identication ofBronchial Branch
Fig. 2.179 EBUS
Fig. 2.180 Fluoroscopy (1)
Fig. 2.181 Fluoroscopy (2)
cranial
caudal
2 Actual Identication ofBronchial Branch
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Left B9a
119
truncus
basalis
8
B
10
B9+B
B9a
9
aii
B
9
ai
B
9
B
aiia
B9a
9
B
b
9
b
B
8
B
9
B
Rotate the
bronchoscope
counter clock wise
B
9
B
8
B
10
B
10
B9b
9
aiia
B
B9aiib
9
B
aiib
ventral
9
B
a
(ventral)
9
aiia
B
8
B
B9aiib
lateral
medial
B9a
B9b
B9aiib
B9aiib
B9aiib
9
aiia
B
(dorsal)
B9ai
(dorsal)
dorsal
B
9
B
aii
(ventral)
10
B9aii
9
ai
B
B9aii b
9
B
aii a
B9aii b
B9aii b
Fig. 2.182 CT, bronchial branch diagram and bronchoscopic ndings
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2 Actual Identication ofBronchial Branch
8
B
9
B
8
B
10
B
10
B
9
B
B9b
9
B
a
10
B
8
B
9
B
aii b
B9b
B9a
9
ai
B
9
B
aii a
B9aii
9
B
ai
B9aii b
9
B
aii a
B9aii
b
Fig. 2.183 Bronchial branch diagram and bronchoscopic ndings
The rotated bronchial branch diagram corresponds to the bronchoscopic ndings
B9aii b
2 Actual Identication ofBronchial Branch
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Fig. 2.184 EBUS (1)
121
Fig. 2.186 EBUS (2)
Fig. 2.185 Fluoroscopy (1)
Fig. 2.187 Fluoroscopy (2)
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