Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree.

PURPOSE: Anatomic variations of the pulmonary arterial tree can cause technical difficulties during pulmonary lobectomy in general and video-assisted thoracic surgery (VATS). Using CT angiography and 3D reconstruction, we sought to identify anatomic variations of the pulmonary arterial tree and assess their respective frequencies. METHODS: We retrospectively studied 88 pulmonary arterial trees in 44 patients having undergone VATS lobectomy for lung cancer over an 18-month period in Amiens University Hospital's Department of Thoracic Surgery. Each CT angiography with 3D reconstruction of the pulmonary arterial tree was performed by two experienced operators, according to a standardized procedure. RESULTS: On the right side, the upper lobe was supplied with blood by a mediastinal artery in 100% of cases and by one or more fissural arteries in 88.6%. The middle lobe was usually supplied by two arteries (54.5%). The upper segment of the right lower lobe was usually supplied by a single artery (90.9%). We identified 11 variations in the vasculature of the basal segments. On the left side, the upper lobe was supplied by four arteries in 50% of cases, three culminal arteries (50%), and a fissural lingular artery (77.3%). The upper segment of the left lower lobe was usually supplied by a single artery (65.9%). We identified 15 anatomic variations in the vasculature of the basal segments. We observed that the origin of the apical artery of the right lower lobe was proximal to the origin of the middle lobe artery in 38.6% of cases. The origin of the apical artery of the left lower lobe artery was proximal to the origin of the lingular fissural artery in 65.9% of cases. CONCLUSION: The findings of the present CT angiography/3D reconstruction study agreed with the reference works on the anatomy of the pulmonary arterial tree and defined the frequency of anatomic variations. It is essential to assess the anatomy of the pulmonary arterial tree before VATS lobectomy.

[Possession of weapons and hunting license]. / Détention d'armes et permis de chasser.

Possession of weapons and hunting license.Firearms are the cause of more than a thousand deaths each year, representing a significant public health goal. For type B and C firearms, sport shooting, and hunting licences, the attending physician plays a crucial role, issuing a certificate in each case according to very specific terms and conditions.

Détention d'armes et permis de chasser. Les armes à feu sont la cause de plus d'un millier de décès chaque année, représentant ainsi un objectif de santé publique conséquent. Pour les armes à feu de type B et C, le tir sportif et le permis de chasse, le médecin traitant joue un rôle crucial, délivrant à chaque fois un certificat selon des modalités bien particulières.