Thorac Surg Clin 17 (2007) 587599

Lobes, Fissures, and Bronchopulmonary Segments

Paula Ugalde, MDa, Jose de Jesus Camargo, MD, FRCS(C)b,
Jean Deslauriers, MD, FRCS(C)a,*
a
Division of Thoracic Surgery, Centre de pneumologie de Laval, 2725, chemin Sainte-Foy,
Sainte-Foy (Quebec) G1V 4G5, Canada
b
Thoracic Surgical Service, Hospital Santa Casa Missericordia de Porto Allegre, Pavilehao, Pereira Filho,
Departamento de Cirurgia Toracica, Av. Independencia, 155 Auxihiadora,
Porte Allegre Rio Grande do Sul CEP90020-090 Brazil

The lungs are paired organs whose primary
function is to provide gas exchange. Because of
that function, however, lungs are exposed to all
kinds of airborne carcinogens, including tobacco
smoke, which predispose them to the development
of lung cancer. Indeed, lung cancer is the most
prevalent form of cancer in men in North America
and it is second in women.
For the pulmonary surgeon, the importance of
having complete knowledge of the anatomy of
lobes, ssures, and bronchopulmonary segments
cannot be overemphasized, because such knowl-
edge will ensure that despite the intricacies of
surgery, he or she will always have control while
in the operating room. Proper identication of
lobes and bronchopulmonary segments as well as of
their detachment planes (ssures) also represents
important information pertinent to the location of
pulmonary lesions. In the preantibiotic era, for
instance, lung abscesses often were treated by
external drainage (Monaldi procedure), so that
understanding the topographic relation between
a given bronchopulmonary segment and the chest
wall was required for a precise surgical approach.
Still today, conservative management of suppura-
tive lung diseases, such as bronchiectasis or lung
abscesses, by promoting external drainage through
postural maneuvers, requires adequate under-
standing of the anatomy and orientation of seg-
mental and lobar bronchi.
* Corresponding author.
E-mail address: hopitallaval.chir-thor@ssss.gouv.qc.ca
(J. Deslauriers).
1547-4127/07/$ - see front matter 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.thorsurg.2006.12.008
In the future, one of the potentially important
benets of understanding the anatomy of bron-
chopulmonary segments will be the ability of
thoracic surgeons to safely perform anatomic
segmental pulmonary resections for treatment of
early lung cancer [13]. Indeed, such procedures,
which were common practice in the early days of
thoracic surgery when surgeons used to do limited
pulmonary resections for bronchiectasis [4] or tu-
berculosis, are likely to become popular again as
part of the overall management of peripherally lo-
cated nonsmall cell lung cancer.
History of thoracic surgery
and the bronchopulmonary segment
The anatomic unit of the lung has long been
recognized as the bronchopulmonary segment.
This unit possesses its own bronchus, pulmonary
arterial, venous, and lymphatic systems, and, as
such, it can be removed individually without
disturbing the function of adjacent segments [5].
In addition, bronchopulmonary segments are con-
stant in their topographic anatomy.
The concept of displaying a general arrange-
ment to the parts contained within the lungs
through small specic units based on bronchial
branches was rst described in 1889 by William
Ewart [6] who came to the conclusion that without
such an arrangement, there could be no systematic
development in the diagnosis and treatment of
pulmonary lesions, especially that of pulmonary
cavities. In his discussion of Ewarts work, Boy-
den [6] correctly noted that this pathologist from
the Brompton Hospital in London had
thoracic.theclinics.com
588 UGALDE et al

anticipated by nearly a half a century the needs of
modern thoracic surgery.
In 1932, two American otorhinolaryngologists,
Kramer and Glass [7], agreed with the concept of
Ewart and suggested that such units be called
bronchopulmonary segments [8]. To be able
to accurately locate lung abscesses and to properly
treat them, Kramer and Glass felt it necessary to
establish smaller and more accurate units of local-
ization than the lobe.
Such reports stimulated the formulation of
a formal nomenclature for bronchopulmonary
segments, and bronchoesophagology became
a well-developed subspecialty of otolaryngology.
Indeed, this specialty is still active today with
societies in several countries and international
meetings held every other year (last meeting in
Buenos Aires, Argentina, June 2006).
In 1943, Jackson and Huber [9] proposed
a simple and consistent system of nomenclature
acceptable to Thoracic surgeons, bronchosco-
pists, radiologists, and anesthetists. Their system,
which has ten segments on the right side and eight
on the left side (Table 1), was also selected in
1945 by Boyden [6] as the most satisfactory. In
1949, the Thoracic Society of Great Britain
formed a committee with the task of clearly den-
ing the anatomy of bronchopulmonary segments
and establishing an internationally acceptable no-
menclature. The recommendations of that com-
mittee and those of an ad hoc International
Table 1
Classication of bronchopulmonary segments
Right lung (10 segments) Left lung (8 segments)
Right upper lobe bronchus Left upper lobe bronchus
(3 segments) (4 segments)
Apical Apical posterior
Posterior Anterior
Anterior Superior lingula
Inferior lingula
Middle lobe bronchus
(2 segments)
Lateral
Medial
Right lower bronchus Left lower lobe bronchus
(5 segments) (4 segments)
Superior Superior
Medial basal Anteromedial basal
Anterior basal Lateral basal
Lateral basal Posterior basal
Posterior basal
Data from Jackson CL, Huber JF. Correlated anat-
omy of the bronchial tree and lung with a system of no-
menclature. Dis Chest 1943;9:31926.
Group led to a signicant report by Brock [10]
published in the medical journal Thorax in
1950. In that report, and in the sixth edition of
Nomina Anatomica [11], the apical segments of
the lower lobes became the superior segments,
and the middle basal segment was changed to lat-
eral basal segment. It was also agreed to use an-
terior and posterior instead of ventral and
dorsal.
Although there are still some discrepancies in
the numerical designation for the various bron-
chopulmonary segments, most surgeons now use
the numerical designation suggested by Jackson
and Huber [9] in 1943 and Boyden [6] in 1945
(Figs. 1 and 2).
Characteristics of bronchopulmonary segments
Each bronchopulmonary segment is pyramidal
in shape with its apex pointing toward the center
of the lung and its base toward the pleural surface
(Box 1). It is surrounded by connective tissue
septas, which are continuous with the pleural sur-
face and prevent air collateralization between seg-
ments somewhat. The segmental bronchus that
runs down the center of the segment (Fig. 3) gives
rise to two or three subsegmental bronchi. Further
branching of the bronchial tree occurs until the
last division, which is called the lobular bron-
chus because it ends in the pulmonary lobule
(physiologic unit of the lung). Corresponding seg-
mental pulmonary artery branches usually accom-
pany segmental bronchi, and they lie on their
posterior surface as far distally as the respiratory
bronchiole.
One main segmental vein drains each broncho-
pulmonary segment, but contrary to the artery
and bronchus, this vein runs in the intersegmental
planes and thus marks the boundaries of each
individual segment. Appreciation of this particu-
larity of the venous drainage is a key to the
clinical application of techniques of anatomic
segmentectomies [12,13]. The drainage pathway
of pulmonary lymphatics is from subpleural ves-
sels to larger channels running along segmental
arteries and bronchi. Eventually, these lymphatics
drain into subsegmental and segmental nodal
stations.
According to Bonls-Roberts and Clagett [14],
segmental resection of the lingula, the superior
segments of both lower lobes, and the apical seg-
ments of both upper lobes is feasible with care,
whereas segmental resection of the anterior
A B
Lateral Medial
(Costal) View (Mediastinal) View

Upper Lobe

LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS

Upper Lobe
Apical (B1)
Apical (B1)
Anterior (B2)
Anterior (B2)
Posterior (B3)
Posterior (B3)

Lower Lobe
Superior (B6)
Lower Lobe
Medial basal (B7)
Superior - Apical (B6)
Posterior basal (B10)
Anterior basal (B8)
Lateral basal (B9)
Middle Lobe
Posterior basal (B10) Middle Lobe
Lateral (B4)
Medial (B5)
Medial (B5)

Fig. 1. Topographic anatomy and numerical designation of right bronchopulmonary segments (N 10). Upper lobe: B1, apical; B2, anterior; B3, posterior. Middle lobe: B4,
lateral; B5, medial. Lower lobe: B6, superior (apical); B7, medial basal (cardiac); B8, anterior basal; B9, lateral basal; B10, posterior basal.

589
 590
A B
Lateral Medial
(Costal) View (Mediastinal) View

Upper Lobe
Apicoposterior (B1 and 3)
Anterior (B2)
Superior lingula (B4) Upper Lobe
Inferior lingula (B5) Apicoposterior (B1 and 3)
Anterior (B2)
Superior lingula (B4)
Lower Lobe Inferior lingula (B5)
Superior - Apical (B6)
Lower Lobe Anteromedial basal (B7 and 8)

UGALDE
Superior - Apical (B6) Posterior basal (B10)
Anteromedial basal (B7 and 8)
Lateral basal (B9)

et al
Posterior basal (B10)

Fig. 2. Topographic anatomy and numerical designation of left bronchopulmonary segments (N 8). Upper lobe: B1 and B3, apico posterior; B2, anterior; B4, superior lin-
gular; B5, inferior lingular. In the Huber nomenclature, the apico-posterior segment (1-3) is only one segment because it arises from a single bronchus. Lower lobe: B6, superior
(apical); B7 and B8, anteromedial basal (cardiac); B9, lateral basal; B10, posterior basal. In the Huber nomenclature, the anteromedial basal segment is only one segment
because it arises from a single bronchus.
 LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS 591

segments of the upper lobes is technically dicult,

Box 1. Characteristic features
of bronchopulmonary segments
 The segments are pyramidal in shape.
 The segments are surrounded by
connective tissue septas.
 Segmental bronchus runs down the
center of the segment.
 Corresponding branch of the
pulmonary artery lies on the posterior
surface of the segmental bronchus.
 Pulmonary veins run in intersegmental
planes and mark boundaries of
individual segments.
and segmental resection of individual basilar seg-
ments of the lower lobes may be extremely di-
cult or even impossible (Box 2).
General anatomy of the lungs
The lungs have the general shape of a half
cone. Both are contained within their own pleural
sac being separated from each other by the
mediastinal pleura and structures of the medias-
tinum (Box 3). The right lung is heavier than the
left, its adult weight being approximately 700 g in
adult men and 500 g in adult women (versus 600 g
for the left lung in men and 450 g in women).

Bronchus

Intersegmental
veins Artery

Intersegmental
plane

Lobule

Subpleural
vein
Pleura

Fig. 3. Anatomy of the bronchopulmonary segment. Note that the draining pulmonary vein circulates in the interseg-
mental plane marking the boundaries of the segment.
592 UGALDE
Box 2. Anatomic resection
of bronchopulmonary segments
 Easy to remove
Lingula
Superior (apical) segments of lower
lobes
Apical segments of upper lobes
 Difficult to remove
Anterior segments of upper lobes
 Very difficult to remove
Individual basilar segments of lower
lobes
Although the right lung is wider than the left, its
vertical extent is less than that of the left, because
the dome of the diaphragm is higher on the right
side than on the left. Their external surfaces are
smooth and blistering because they are entirely
covered by the densely adherent visceral pleura.
In adults, the lungs have a bluish color, and
their outer surface often is darkly pigmented with
irregular anthracotic deposits. They have a convex
outer surface in contact with the ribs and costo-
vertebral gutter posteriorly, a straight mediastinal
surface, an apex that protrudes at the base of the
neck 3 cm above the medial third of the clavicle,
and a concave base that takes the shape of the
corresponding hemidiaphragm.
In adults, the total amount of air contained in
the lungs after a deep inspiration (Total lung
capacity) is approximately 5 L.
Anatomy of interlobar ssures
Interlobar ssures are deep depressions that
extend from the outer surface of the lung to its
Box 3. General characteristics
of the lungs
 Lungs are in the shape of half cones.
 Lungs are contained within their own
pleural sac.
 The right lung is heavier and wider
than the left.
 Vertical extent of the left lung is more
than that of the right lung.
 They have smooth external surfaces.
 Total lung capacity is approximately
5 L.
et al
very center (Box 4). The visceral pleura, which
cover all lung surfaces, also dips deep into the s-
sures so that in those areas, the visceral pleura of
adjacent lobes is in contact. Because of this pleu-
ral covering, lung surfaces lying within the ssures
are smooth and thus allow individual lobes to
move freely with respect to one another. The left
lung is divided into a superior and a lower lobe
by an oblique ssure (Fig. 4), whereas on the right
(Fig. 5) a horizontal ssure (minor ssure) sepa-
rates the upper and middle lobes, and an oblique
ssure separates the lower lobe from the upper
and middle lobes.
On the left side, the oblique ssure extends
from the tip of the spinous process of T3
posteriorly to the sixth costochondral junction
anteriorly, and through this route, it follows
approximately the path of the sixth rib. On the
right side, the posterior projection of the oblique
ssure is slightly lower than that of the left, being
at the lower margin of T4. It is generally agreed
that the left oblique ssure is more vertical than its
right counterpart.
The horizontal or minor ssure is only present
on the right side. It is generally less well developed
than any of the oblique ssures, and it separates
Box 4. Normal fissures of the lungs
Oblique (major) fissure of the left lung:
 Separates upper from lower lobe
 Extends from T3 posteriorly to the
sixth costochondral junction
anteriorly
 Is more vertical than the right
oblique fissure
Oblique (major) fissure of the right lung:
 Separates upper and middle lobes
from lower lobe
 Extends from T4 posteriorly to the
sixth costochondral function
anteriorly
 Is more oblique than the left oblique
fissure
Horizontal (minor) fissure of the right
lung:
 Separates upper and middle lobes
 Extends from the oblique fissure in
the midaxillary line to the level of
the fourth intercostal cartilage
 Is often incomplete
 Depression Depression
created by created by
the first rib the first rib

LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS

Oblique
(Major) Horizontal
fissure (Minor)
fissure

Cardiac
notch

Oblique
(Major)
fissure

Lingula
Fig. 5. Costal or external surface of the right lung, shows the separation of the up-
Fig. 4. Costal or external surface of the left lung shows the separation of upper lobe per lobe from the middle lobe by the horizontal (minor) ssure and of the upper
and lower lobe by the oblique (major) ssure. and middle lobes from the lower lobe by the oblique (major) ssure.

593
594
the upper lobe from the middle lobe. The hori-
zontal ssure originates from the oblique ssure in
the mid axillary line at the level of the sixth rib,
and it runs transversally to the level of the fourth
costal cartilage (see Fig. 5).
Although the anatomy of interlobar ssures is
rather constant, variations can occur even in
healthy individuals. Fissures are called complete
when the lobes are only held together at the hilar
level (by bronchi and pulmonary blood vessels),
and they are called incomplete when there are
areas of parenchymal fusion between the lobes.
Indeed, a signicant proportion of ssures in the
adult population are incomplete, and adjacent
lobes merge together. In an interesting study on
the variations in interlobar ssures, Medlar [15]
examined 1200 pairs of lungs and reported that
oblique ssures were incomplete in 17.9% and
30.4% of the left and right lungs respectively,
and that horizontal ssures were incomplete in
62.3% of right lungs. In a number of normal indi-
viduals, the horizontal ssure can be completely
absent or only marked by a supercial depression
on the outer surface of the lung.
Occasionally, there will be extra ssures de-
marcating accessory lobes or segments. The so-
called cardiac lobes correspond to the medial
basal segments of the lower lobes, which become
demarcated by an intersegmental ssure. The
azygos lobe (1% of normal individuals) is
caused by an anomaly of the arch of the azygos
vein, which creates a depression (ssure) from the
top to the bottom of the right upper lobe. Because
of this anomaly, the apical segment of the right
upper lobe lies on the medial or mediastinal side
of the depression, which shows as a linear mark-
ing on standard chest radiographs.
Anatomy of the pulmonary lobes of the right lung
The right lung has three lobes: upper, middle,
and lower (Box 5, Fig. 6). The right upper lobe
could have easily been named upper anterior
lobe because it has a large projection anteriorly
and a small projection posteriorly. The middle
lobe projects only anteriorly, whereas the lower
mostly projects posteriorly.
Right upper lobe
The right upper lobe bronchus formally called
the eparterial bronchus originates at right angle
from the right main bronchus approximately 1.5
to 2.0 cm distal to the carina. It is 1 cm long
UGALDE et al
Box 5. Anatomic characteristics
of individual lobes of the right lung
Right upper lobe
 Has large anterior projection
 Supplies three segments
 Is smaller than the left upper lobe
 Origin of the right upper lobe
bronchus or of apical segment is
anomalous in 3% of normal
individuals (tracheal bronchus)
Middle lobe
 Only has anterior projection
 Supplies two segments
 Is wedge-shaped in outline
Right lower lobe
 Lies inferior and posterior to the
oblique major fissure
 Supplies five segments
 Inferior surface lies over the
diaphragmatic dome
(diaphragmatic surface)
before dividing into three segmental bronchi
supplying the apical (B1), the anterior (B2), and
the posterior (B3) segments, respectively. It is
smaller than its left counterpart, and it has a cost-
overtebral external surface related to the curva-
ture of the ribs and to the spine, a mediastinal
internal surface, and a lower ssural surface.
The origin of the right upper lobe bronchus
often is anomalous (3% of normal people [16]),
and the most common of such anomalies is that
of the apical segmental bronchus of the right up-
per lobe bronchus originating directly from the
right lateral wall of the trachea or right main
bronchus (Fig. 7).
Middle lobe
Proceeding distally from the take-o of the
right upper lobe bronchus, the right primary
bronchus is called the bronchus intermedius
(see Fig. 6), which has a total length of 1.5 to
2.0 cm. It then gives rise anteriorly to the middle
lobe bronchus, which divides into two segmental
bronchi supplying the lateral (B4) and medial seg-
ments (B5).
The middle lobe is a small and wedge-shaped
lobe that forms the anteroinferior part of the right
lung. Its superior surface is in contact with the
A B

Right Right upper

upper lobe lobe bronchus
bronchus

LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS

Bronchus
intermedius Middle lobe
bronchus

Middle lobe
bronchus
Lower lobe
bronchus

Lower lobe
bronchus

Fig. 6. Anterior and lateral views of the right bronchial tree.

595
596 UGALDE et al

Tracheal
bronchus

Fig. 7. Diagram shows a tracheal bronchus supplying the apical segment of the right upper lobe.

Box 6. Anatomic characteristics of individual lobes of the left lung

Left upper lobe

 Is much bigger than the right upper lobe
 Has large anterior projection
 Supplies four segments
 Has a wide cardiac notch anteriorly
 Has lingola, which is a small tonguelike projection located antero-inferiorly
Left lower lobe
 Is larger than the upper lobe
 Lies inferior and posterior in the oblique major fissure
 Supplies four segments
A B

Superior Left main

truncus (Culmen) bronchus

LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS

Left upper
lobe bronchus
Left main
bronchus

Left upper
lobe bronchus
Left lower
Lingular lobe bronchus
bronchus
Left lower Apical segmental
lobe bronchus bronchus of left
lower lobe

Fig. 8. Anterior and lateral views of the left bronchial tree.

597
598 UGALDE
right upper lobe through the horizontal ssure,
whereas its lower surface is in contact with the
right lower lobe through the oblique ssure and
with the dome of the right hemidiaphragm.
Right lower lobe
The right lower lobe lies inferior and posterior
to the oblique ssure. The rst segmental branch
of the right lower lobe bronchus, the superior
segmental (apical) bronchus (B6), originates from
its posterior wall slightly distal to the origin of
the middle lobe bronchus (middle lobe bronchus
and right lower lobe bronchus form the termina-
tion of the bronchus intermedius). The basal
stem bronchus sends o four basal segmental
bronchi to supply four basal segments (medial
basal segment [B7]; anterior basal segment [B8];
lateral basal segment [B9], and posterior basal seg-
ment [B10]).
The right lower lobe has a large concave
diaphragmatic surface, an anterolateral cardiac
surface, an external outer and costal surface, and
an anterior ssural surface where it is in contact
with the upper lobe and the middle lobe through
the oblique ssure.
Anatomy of the pulmonary lobes of the left lung
The left lung has two lobes: upper and lower
(Box 6, Fig. 8). The left upper lobe has a large
contact anteriorly, whereas the left lower lobe
mostly projects posteriorly. They are separated
by a major oblique ssure that follows approxi-
mately the same course as the one on the right
side. The left lung is made of 8 segments (versus
10 on the right side) because of sharing of the
segmental bronchi by subsegmental broncho-
pulmonary units, which in the right lung are con-
sidered to be individual segments [5].
Left upper lobe
The left upper lobe bronchus arises anterolat-
erally from the main bronchus at a distance of
approximately 4 to 5 cm from the carina. It bifur-
cates almost immediately into a superior trunk
(culmen), which subdivides into an anterior seg-
mental bronchus (B2) and a much larger common
trunk for the apicoposterior segment (B1 and 3)
and an inferior trunk forming the lingular
orice, which gives rise to the superior (B4) and in-
ferior (B5) lingular bronchopulmonary segments.
The left upper lobe has a wide cardiac notch on
its anterior border (indentation caused by the
et al
heart). The lingula, considered to be the equiva-
lent of the middle lobe, is a small tonguelike
projection located antero-inferiorly. The left up-
per lobe is much larger than its counterpart on the
right side.
Left lower lobe
The left lower lobe bronchus is the termination
of the left main bronchus, and its general topo-
graphic anatomy is similar to that on the right
side. At about half a centimeter from its origin, it
gives rise posteriorly and laterally to the rst
segmental bronchus (superior segmental bron-
chus, B6). More distally (distance of 1.5 cm), the
basal trunk gives rise to the anteromedial (B7
and B8), lateral basal (B9), and posterior basal
(B10) segments. Contrary to the anatomy of the
right lower lobe, the anterior and medial segments
originate from a single branch of the lower lobe
bronchus and are thus considered to be only one
segment. The left lower lobe is larger than the
left upper lobe and it lies inferior and posterior
to the oblique ssure.
Summary
The clinical practice of thoracic surgery re-
quires the surgeon to have intimate knowledge of
pulmonary anatomy and of its variations. At-
tempts to perform thoracic procedures without
this knowledge can only result in incomplete
operations or technical mishaps. Proper under-
standing of the anatomy of the pulmonary lobes,
segments, and ssures allows the surgeon to
correlate imaging, pathologic processes, and pos-
sible resectional procedures, thus insuring that
each patient gets the best possible operation.
Further readings
Moore KL. Clinically oriented anatomy. 2nd edition.
Baltimore (MD): Williams and Wilkins; 1985.
Rosse C, Gaddum-Rosse P. Hollinsheds textbook of
anatomy. Philadelphia: Lippincott-Raven; 1997.
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 LOBES, FISSURES AND BRONCHOPULMONARY SEGMENTS
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