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Measurements of the right and left main bronchi in situ in a male fetus aged 19 weeks: A trachea, B right main bronchus, C left main bronchus, 1 length of right main bronchus, 2 length of left main bronchus, 3 proximal external diameter of right main bronchus, 4 proximal external diameter of left main bronchus, 5 distal external diameter of right main bronchus, 6 distal external diameter of left main bronchus, 7 projection surface area of right main bronchus, 8 projection surface area of left main bronchus
Source publication
Purpose:
Intensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bro...
Context in source publication
Context 1
... optical lens axis, photographed with the use of Nikon D200 camera, and digitalized to TIFF images. Next, native pic- tures of every tracheobronchial segment were subjected to digital image analysis (NIS-Elements BR 3.0, Nikon), so as to evaluate semi-automatically the following eight inde- pendent variables for the right and left main bronchi ( Fig. 1): 1, 2. lengths, 3, 4. proximal external transverse diameters, 5, 6. distal external transverse diameters, and 7, 8. projection surface areas. Furthermore, since the fetuses varied in size, the two indexes of the two main bronchi were calculated, as ...
Citations
... Finally, we have included subjects >12 years of age. This choice was made according to the studies of Szpinda et al. [17,18], in which, it was shown that airways continue to develop at early life in size and diameter and accepting cases in childhood might lead us to miss variations. ...
Objectives:
There are various anatomic variations in the tracheobronchial system. The frequency in studies with bronchoscopy was contradictory. This study aimed to investigate the tracheobronchial tree of the deceased patients with anatomical dissection.
Material and methods:
We made anatomical dissections on 204 cases in the Council of Forensic Medicine, Ministry of Justice. The deceased patients who were older than 12 years of age and of Turkish origin were included in this study consecutively.
Results:
Of the 204 cases, 161 (78.9%) were males and 43 (21.1%) were females. The mean age was 44.15±19.23 years. Anatomical variations were found to be present in 200 cases (98% of total). The highest degree of variation of the right upper lobe was noted to be 16.6% (34/204). An anomalous arrangement (with three segments or different placement) of the middle lobe was noted in 16.1% of cases. For the basal lower lobe, b8+(b9+b10) pattern and basal orifice with four segments were noted to be the most frequent anatomical variant in the right and left lungs, respectively. The most frequent tracheobronchial variations were as follows: apical basal lobe with two subsegments in the right and left (39.7%), left lower lobe basal orifice with four segments (34.8%), left upper lobe with three segments (25.5%), and right lower lobe basal orifice with three main segmental bronchi (21.1%).
Conclusion:
The tracheobronchial tree exhibits highly individualistic features. The knowledge of the frequency of different variations obtained in different studies and normal anatomic variants in return makes doing therapeutic or diagnostic interventions easier and more accurate.
... The study was approved by the Bioethics Committee of Nicolaus Copernicus University in Toruń (KB 161/2013). The fetal ages were determined on the crown-rump length due to the tables provided by Iffy et al. [19][20][21][22][23][24][25][26][27][28][29], and the known date of the beginning of the last maternal menstrual period. The fetuses fixed in 10% neutral formalin solution were subjected to conventional anatomical dissection. ...
This study aimed to examine age-specific reference intervals and growth dynamics of the best fit for liver dimensions on the diaphragmatic surface of the fetal liver. The research material consisted of 69 human fetuses of both sexes (32♂, 37♀) aged 18–30 weeks. Using methods of anatomical dissection, digital image analysis and statistics, a total of 10 measurements and 2 calculations were performed. No statistical significant differences between sexes were found (p>0.05). The parameters studied displayed growth models that followed natural logarithmic functions. The mean value of the transverse–to–vertical diameter ratio of the liver throughout the analyzed period was 0.71±0.11. The isthmic ratio decreased significantly from 0.81±0.12 in the 18–19th week to 0.62±0.06 in the 26–27th week, and then increased to 0.68±0.11 in the 28–30th week of fetal life (p<0.01). The morphometric parameters of the diaphragmatic surface of the liver present age-specific reference data. No sex differences are found. The transverse–to–vertical diameter ratio supports a proportionate growth of the fetal liver. Quantitative anatomy of the growing liver may be of relevance in both the ultrasound monitoring of the fetal development and the early detection of liver anomalies.
... Fetal age determination was based on the crown-rump length (CRL), known date of the 1 st day of the maternal menstrual period, and the 5 fetal anthropometric measurements (head circumference, bi-parietal diameter, occipitofrontal diameter, abdominal circumference, and femur length) assessed by early 2 nd trimester ultrasound scans. [18][19][20][21][22][23][24][25][26] As a prerequisite, we excluded fetuses with chromosomal abnormalities or intrauterine growth restriction, as well as from multiple pregnancies, from diabetic mothers and those with severe infections. ...
... According to the professional literature, shrinkage in formalin did not exceed 1% with reference to any linear dimension of the liver. [18][19][20][21][22][23][24][25][26][27] Furthermore, the size of the liver in situ was virtually unfettered by formalin solution, since some liver linear dimensions, i.e., height, as well as transverse and sagittal diameters, achieved in the present series, accurately corresponded with those obtained by Chang et al., when measuring in utero fetuses of the same age with the use of 3D-ultrasound. 3 Thirdly, in order to measure the liver parameters, an optimized digital image system (NIS-Elements AR 3.0.; Nikon) was used. ...
Background:
Understanding liver growth is relevant in both determining the status of normative fetal development and prenatal detection of its disorders.
Objectives:
This study attempted to examine age-specific reference intervals and the best-fit growth dynamics of the liver visceral surface for hepatic height, length, isthmic diameter, oblique diameters, circumferences of individual lobes, and total liver circumference.
Material and methods:
Using anatomical, digital and statistical methods, the liver visceral surface was measured in 69 human fetuses of both sexes (32 males and 37 females) aged 18-30 weeks, derived from spontaneous abortions and stillbirths.
Results:
The statistical analysis showed no sex differences. The best growth models mostly followed natural logarithmic functions, except for the length of the fissure for ligamentum teres hepatis and the length of fossa for gallbladder, which increased commensurately. Neither the length of fissure for ductus venosus nor the length of sulcus for inferior vena cava modeled the best-fit curves. The vertical-to-transverse diameter ratio of the liver was constant and averaged 0.75 ±0.12, while the isthmus ratio significantly altered from 0.78 ±0.07 at 18-19 weeks through 0.68 ±0.05 at 26-27 weeks to 0.72 ±0.07 at 28-30 weeks of gestation.
Conclusions:
With no sexual differences, the liver morphometric parameters increased either logarithmically (lengths of: transverse diameter, vertical diameter, right oblique diameter, left oblique diameter, isthmic diameter and porta hepatis, circumferences of: right lobe, left lobe, quadrate lobe, caudate lobe, and total liver circumference) or proportionately (length of fissure for ligamentum teres hepatis, length of fossa for gallbladder). The quantitative data of the growing liver may be relevant in both the ultrasound monitoring of fetuses and early detection of congenital liver anomalies.
... Advances in perinatal medicine result in the early recognition and prompt implementation of corrective procedures in the fetus with life-threatening congenital malformations of the respiratory system [16]. As a prerequisite, a widespread understanding of fetal quantitative anatomy is clearly required so as to produce both normative and pathological criteria adapted to fetal and neonatal respiratory structures [9,17]. Thus, the current research refers to morphometric analysis of the fetal lungs, providing the existing medical literature with innovative quantitative data. ...
... Finally, the lowest 2 values characterized the height of the right lung ( 2 = 0.63) and the remaining two features of the left lung, that is, transverse diameter ( 2 = 0.59) and base circumference ( 2 = 0.68). In terms of mathematics, a logarithmic relationship is always one-to-one, continuous, and increasing with a declining rate of change, clearly presented as a concave down graph [15,17]. This means that an increase in length of the six pulmonary parameters studied gradually decelerated, inexorably deviating downwards from an imaginary axis ( = ). ...
Using anatomical, digital, and statistical methods we examined the three-dimensional growth of the lungs in 67 human fetuses aged 16–25 weeks. The lung dimensions revealed no sex differences. The transverse and sagittal diameters and the base circumference were greater in the right lungs while the lengths of anterior and posterior margins and the lung height were greater in the left lungs. The best-fit curves for all the lung parameters were natural logarithmic models. The transverse-to-sagittal diameter ratio remained stable and averaged
0.56
±
0.08
and
0.52
±
0.08
for the right and left lungs, respectively. For the right and left lungs, the transverse diameter-to-height ratio significantly increased from
0.74
±
0.09
to
0.92
±
0.08
and from
0.56
±
0.07
to
0.79
±
0.09
, respectively. The sagittal diameter-to-height ratio significantly increased from
1.41
±
0.23
to
1.66
±
0.18
in the right lung, and from
1.27
±
0.17
to
1.48
±
0.22
in the left lung. In the fetal lungs, their proportionate increase in transverse and sagittal diameters considerably accelerates with relation to the lung height. The lung dimensions in the fetus are relevant in the evaluation of the normative pulmonary growth and the diagnosis of pulmonary hypoplasia.
... The study encompassed a group consisting of 69 autopsied human fetuses of both sexes (32 males, 37 females) aged 18-30 weeks of Caucasian origin (Table 1), derived from spontaneous abortions or stillbirths in the years 1989-1999. According to the INTERGROWTH-21st Project, the fetal ages in weeks were fine-tuned by the following criteria: the fetal crown-rump length (gestational age), known date of the beginning of the last maternal menstrual period (amenorrhea age), and known values of the five fetal anthropometric measurements: head circumference, bi-parietal diameter, occipitofrontal diameter, abdominal circumference, and femur length assessed by early second trimester ultrasound scan (ultrasound age) [4,18,[23][24][25][26][27][28]31]. The crown-rump length was measured with the use of a flexible caliper from the top of the head (crown) to the bottom of the buttocks (rump) of the fetus in its natural C-shaped posture [16]. ...
... Legal and ethical considerations were approved by the University Research Ethics Committee (reference: KB 161/2013). After having been immersed in 10 % neutral buffered formalin solution for 12-24 months [4,11,16,[23][24][25][26][27][28], the fetuses were anatomically dissected through median and transverse laparotomy under tenfold magnification using a stereoscope with Huygens ocular (Fig. 1). After opening the abdominal cavity, the hepatic ligaments, abdominal diaphragm, inferior vena cava and structures at the porta hepatis were cut off, and then the liver was removed out. ...
... However, the assumption that fetuses could suffer from intrauterine growth retardation was unambiguously disapproved, because the correlation coefficient between the gestational age based on the crown-rump length and that calculated by either the amenorrhea age or ultrasound age reached the value R = 0.99 (P \ 0.001) for the whole sample. 6 Length-to-transverse diameter ratio and sagittal-totransverse diameter ratio of the liver calculated for the 50th centile vs. gestational age fetal ages [4,18,[23][24][25][26][27][28]31]. The Fetal Growth Longitudinal Study prospectively assessed fetal growth from 14 to 42 weeks of gestation in 4,321 mothers who were at low risk of intrauterine growth restriction (optimal health and nutritional maternal wellbeing, satisfactory antenatal care, singletons without congenital malformations) in eight geographically diverse urban populations [18]. ...
The fetal liver is indubitably the earliest and the most severely affected organ by abnormal fetal growth. The size of the fetal liver assessed by three-dimensional ultrasonography is indispensable in determining the status of fetal growth, nutrition and maturity, and in the early recognition and monitoring fetal micro- and macrosomias. The aim of the present study was to measure the human fetal liver length, transverse and sagittal diameters to establish their age-specific reference intervals, the 3rd, 10th, 50th, 90th, and 97th smoothed centile curves, and the relative growth of the liver calculated for the 50th centile.
Using anatomical, digital (NIS-Elements AR 3.0, Nikon) and statistical methods (one-way ANOVA test for paired data and post hoc RIR Tukey test, Shapiro-Wilk test, Fisher's test, Student's t test, the Altman-Chitty method), length, transverse and sagittal diameters of the liver for the 3rd, 10th, 50th, 90th, and 97th centiles were assessed in 69 human fetuses of both sexes (32 males and 37 females) aged 18-30 weeks, derived from spontaneous abortions or stillbirths.
No male-female differences (P > 0.05) concerning the three parameters studied were found. During the study period, the fetal liver increased tri-dimensionally: in length from 19.51 ± 1.02 to 39.65 ± 7.05 mm, in transverse diameter from 29.44 ± 3.73 to 53.13 ± 5.31 mm, and in sagittal diameter from 22.97 ± 3.79 to 43.22 ± 5.49 mm. The natural logarithmic models were found to fit the data with gestational age (P < 0.001) in the following five cutoff points: 3rd, 10th, 50th, 90th and 97th centiles. The values of liver parameters in relation to gestational age in weeks were calculated by the following logarithmic regressions: y = -82.778 + 35.752 × ln(age) ± Z × (-2.778 + 0.308 × age) for liver length, y = -123.06 + 52.668 × ln(age) ± Z × (3.156 + 0.049 × age) for liver transverse diameter, and y = -108.94 + 46.052 × ln(age) ± Z × (-0.541 + 0.188 × age) for liver sagittal diameter. For the 50th centile, at the range of 18-30 weeks, the growth rates per week were gradually decreasing from 1.93 to 1.21 mm for length, from 2.85 to 1.79 mm for transverse diameter, and from 2.49 to 1.56 mm for sagittal diameter of the liver (P < 0.05). During the study period both the length-to-transverse diameter ratio and the sagittal-to-transverse diameter ratio of the liver changed little, attaining the values of 0.71 ± 0.11 and 0.87 ± 0.12, respectively.
The fetal liver does not reveal sex differences in its length, transverse and sagittal diameters. The fetal liver length, transverse and sagittal diameters grow logarithmically. The regression equations for the estimation of the mean and standard deviation of liver length, transverse and sagittal diameters allow for calculating any desired centiles according to gestational age. The three-dimensional evolution of the fetal liver follows proportionately. The age-specific reference intervals for evolving liver length, transverse and sagittal diameters constitute the normative values of potential relevance in monitoring normal fetal development and screening for disturbances in fetal growth.
The symmetry of the right and left bronchi, proposed in a previous comparative anatomical study as the basic model of the mammalian bronchial tree, was examined to determine if it applied to the embryonic human bronchial tree. Imaging data of 41 human embryo specimens at Carnegie stages (CS) 16-23 (equivalent to 6-8 weeks after fertilization) belonging to the Kyoto collection were obtained using phase-contrast X-ray computed tomography. Three-dimensional bronchial trees were then reconstructed from these images. Bronchi branching from both main bronchi were labeled as dorsal, ventral, medial, or lateral systems based on the branching position with numbering starting cranially. The length from the tracheal bifurcation to the branching point of the labeled bronchus was measured, and the right-to-left ratio of the same labeled bronchus in both lungs was calculated. In both lungs, the human embryonic bronchial tree showed symmetry with an alternating pattern of dorsal and lateral systems up to segmental bronchus B9 as the basic shape, with a more peripheral variation. This pattern is similar to that described in adult human lungs. Bronchial length increased with the CS in all labeled bronchi, whereas the right-to-left ratio was constant at approximately 1.0. The data demonstrated that the prototype of the human adult bronchial branching structure is formed and maintained in the embryonic stage. The morphology and branching position of all lobar bronchi and B6, B8, B9, and the subsegmental bronchus of B10 may be genetically determined. On the other hand, no common structures between individual embryos were found in the peripheral branches after the subsegmental bronchus of B10, suggesting that branch formation in this region is influenced more by environmental factors than by genetic factors.
Objective:
To develop Z scores for the trachea and main bronchi in normal fetuses.
Methods:
This was a prospective cross-sectional study in 823 normal singleton fetuses. The tracheal diameter immediately proximal to the bifurcation and the left and right main bronchial diameters were measured from their inner to inner edge in the coronal view. Z scores were created for the trachea and main bronchial diameters using gestational age (GA), femur length (FL), and biparietal diameter (BPD) as independent variables.
Results:
Between gestational weeks 20 and 40, the inner diameters of the trachea, left principal bronchi (LPB), and right principal bronchi (RPB) increased from 1.8 to 4.7 mm, 0.8 to 2.2 mm, and 0.9 to 2.3 mm, respectively. A simple linear regression equation was fitted to model the mean of each diameter. There was however significant heteroscedasticity of the standard deviation (SD) with increasing GA, FL, or BPD. Eventually, the following formula was used to calculate Z scores for the diameters: [measured value - equation for mean]/equation for SD.
Conclusion:
We have developed Z scores for the fetal trachea and main bronchi by applying standard statistical methods. These Z scores may be useful to evaluate the early development of the respiratory system.
