PURPOSE: Identification of anatomical bronchial variations (ABV) may have significant clinical and therapeutic implications. The frequency of ABV is not constant between published series. Our purpose was to assess the frequency and type of ABV in a random sample of Greek patients undergoing bronchoscopy for various indications.
METHODS: Video recordings from flexible bronchoscopy examinations were retrospectively studied from two bronchoscopists and variations up to the segmental bronchi were recorded.
RESULTS: 113 adult patients of greek origin were studied (74 male, 39 female, mean age 62.2). In only 32 patients (28%) was the bronchial tree anatomy compatible with the commonly illustrated pattern. In the remaining 81 patients we recorded 141 ABV: 80 ABV on the right and 61 on the left bronchial tree. 100 ABV were found in 53 men and 41 ABV in 28 women (p<0.01). The most common ABV were: right upper lobe bifurcation in 27 patients (24%), absence of a separate medial basal segment on the right in 22 patients (19%), trifurcation of the left upper lobe division in 14 patients (12%), a subapical segment on the right lower lobe in 12 patients (11%) and on the left in 11 patients (10%), a separate medial basal segment on the left in 9 patients (8%) and left upper lobe trifurcation in 8 patients (7%). Bilateral ABV were seen in 30 patients (26%). 36 rare ABV (encountered in <5% patients) were seen in 26 patients (23%). 10 variations of lobar bronchi, including a case of a tracheal bronchus, were seen 10 patients (9%).
CONCLUSIONS: ABV were observed in 72% of a random sample of 113 Greek patients undergoing flexible bronchoscopy. Frequency and type of ABV differed from published series.
CLINICAL IMPLICATIONS: Identification of the bronchial anatomy is an essential part of the bronchoscopic examination. Frequency and type of ABV may depend on gender, ethnicity and diagnostic method. Moreover, it is possible that ABV may be correlated with certain pulmonary diseases. A larger patient population and subgroup analysis is necessary to examine these suppositions.
DISCLOSURE: The following authors have nothing to disclose: Konstantinos Kotsifas, Evangelos Balis, Eugenios Metaxas, Vicky Lazarou, Stavroulia Boulia, George Tatsis
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