The development of the bronchopulmonary segments in human embryos of horizons XVII to XIX

Bronchial tree of the human embryo: Examination based on a mammalian model

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.

Bronchial tree of the human embryo: Categorization of the branching mode as monopodial and dipodial

Some human organs are composed of bifurcated structures. Two simple branching modes—monopodial and dipodial—have been proposed. With monopodial branching, child branches extend from the sidewall of the parent branch. With dipodial branching, the tip of the bronchus bifurcates. However, the branching modes of the human bronchial tree have not been elucidated precisely. A total of 48 samples between Carnegie stage (CS) 15 and CS23 belonging to the Kyoto Collection were used to acquire imaging data with phase-contrast X-ray computed tomography. Bronchial trees of all samples were three-dimensionally reconstructed from the image data. We analyzed the lobar bronchus, segmental bronchus, and subsegmental bronchus. After calculating each bronchus length, we categorized the branching mode of the analyzed bronchi based on whether the parent bronchus was divided after generation of the analyzed bronchi. All lobar bronchi were formed with monopodial branching. Twenty-five bifurcations were analyzed to categorize the branching mode of the segmental and subsegmental bronchi; 22 bifurcations were categorized as monopodial branching, two bifurcations were not categorized as any branching pattern, and the only lingular bronchus that bifurcated from the left superior lobar bronchus was categorized as dipodial branching. The left superior lobar bronchus did not shorten during the period from CS17 or CS18, when the child branch was generated, to CS23. All analyzed bronchi that could be categorized, except for one, were categorized as monopodial branching. The branching modes of the lobar bronchus and segmental bronchus were similar in the mouse lung and human lung; however, the modes of the subsegmental bronchi were different. Furthermore, remodeling, such as shrinkage of the bronchus, was not observed during the analysis period. Our three-dimensional reconstructions allowed precise calculation of the bronchus length, thereby improving the knowledge of branching morphogenesis in the human embryonic lung.

Left/right difference in the course and division of the pulmonary arterial branches in the lung upper lobe: A study using human embryos and early fetuses

Although left/right differences in a configuration of the pulmonary artery (PA) and its branches are well known, there is little information as to when and how such differences are established. Examination of serial sagittal sections of 25 embryos and fetuses at 6-7 weeks of gestation demonstrated that, at O'Rahilly stages 18-20, the right earliest first branch of PA originated in the anterior side of the upper lobar bronchus and overlay the upper bronchi, in contrast to the left branch which was located posteriorly and constricted medially by the upper posterior bronchus B1 + 2b. The right earliest branch was most likely to correspond to the future superior trunk, while the left branch might be a lingual artery. At stages 21-23, the upper posterior parenchyma was still underdeveloped in the left lung, since the ductus arteriosus and the left common cardinal vein seemed to make the left upper thoracic cavity narrow. Conversely, in the right lung, the thick S2 seemed to require a double arterial supply from both the superior and inferior arterial trunks. On the left, A3 originated at the lung apex and took a long descending course along the lung anterior surface. This high position of A3 might soon be corrected by an increased volume of S3. Overall, in contrast to the lower and middle lobes, early-developed branches of the PA did not accompany upper segmental and subsegmental bronchi. A mechanism "differential growth" seemed to explain how to correct the fetal morphology to provide the adult morphology with variations.

Three-dimensional analysis of the segmental arrangement of lower lung lobes in human fetuses: is this arrangement a miniature version of adult morphology?

Knowledge of the lung segment system is essential for understanding human anatomy and has great clinical relevance. The arrangement of 11 segments, including the S* or subsuperior segment, and its individual variations, are considered to be the same in fetal and adult lungs. The present study assessed the topographical anatomy of lower segmental and subsegmental bronchi by computer-assisted three-dimensional imaging of serial sagittal sections of both lungs of 22 embryos and fetuses of gestational age 6-7 weeks (crown-rump length 15.0-28.5 mm). Long inferior courses of B8b (basal) and B10c (medial) were observed in sagittal sections of both lungs. B8a (lateral) and B10b (lateral) in the right lungs were consistently underdeveloped, with S9 occupying most of the lateral half of the lower lobe. In some samples, B6b (lateral) did not reach the lateral surface. The lateral dominance of S9 was also seen in the left lungs. Some B* candidates were present, but B7 candidates were absent. Lateral and posterior expansions of S6b, S8a and S10b to cover S9 were observed in additional midterm and near-term lung sections, indicating that the original S9 dominance was 'corrected' by an increase in lung volume. Delayed growth of the lower lateral subsegments might induce mechanical stress, resulting in aberrant notches or fissures, such as those separating an independent posterior lobe. The segmental arrangement of fetal lungs was not stable, but was altered over a long fetal period after the complete subsegmental division of the bronchi, except for the minor bronchi B* and B7.

The bronchial tree of the human embryo: an analysis of variations in the bronchial segments

A classical study has revealed the general growth of the bronchial tree and its variations up to Carnegie stage (CS) 19. In the present study, we extended the morphological analysis CS by CS until the end of the embryonic period (CS23). A total of 48 samples between CS15 and CS23 belonging to the Kyoto Collection were used to acquire imaging data by performing phase-contrast X-ray computed tomography. Three-dimensionally reconstructed bronchial trees revealed the timeline of morphogenesis during the embryonic period. Structures of the trachea and lobar bronchus showed no individual difference during the analyzed stages. The right superior lobar bronchus was formed after the generation of both the right middle lobar bronchus and the left superior lobar bronchus. The speed of formation of the segmental bronchi, sub-segmental bronchi, and further generation seemed to vary among individual samples. The distribution of the end-branch generation among five lobes was significantly different. The median branching generation value in the right middle lobe was significantly low compared with that of the other four lobes, whereas that of the right inferior lobe was significantly larger than that of both the right and left superior lobes. Variations found between CS20 and CS23 were all described in the human adult lung, indicating that variation in the bronchial tree may well arise during the embryonic period and continue throughout life. The data provided may contribute to a better understanding of bronchial tree formation during the human embryonic period.

Human embryonic ribs all progress through common morphological forms irrespective of their position on the axis

BACKGROUND

We aimed to analyze the morphogenesis of all ribs from 1st to 12th rib pairs plus vertebrae to compare their differences and features according to the position along the cranial-caudal axis during the human embryonic period.

RESULTS

Rib pair formation was analyzed using high-resolution digitalized imaging data (n = 29) between Carnegie stage (CS) 18 and CS23 (corresponding to ED13-14 in mouse; HH29-35 in chick). A total of 348 rib pairs, from 1st to 12th rib pairs of each sample were subjected to Procrustes and principal component (PC) analyses. PC1 and PC2 accounted for 76.3% and 16.4% (total 92.7%) of the total variance, respectively, indicating that two components mainly accounted for the change in shape. The distribution of PC1 and PC2 values for each rib showed a "fishhook-like shape" upon fitting to a quartic equation. PC1 and PC2 value position for each rib pair moved along the fitted curve according to the development. Thus, the change in PC1 and PC2 could be expressed by a single parameter using a fitted curve as a linear scale for shape.

CONCLUSION

Human embryonic ribs all progress through common morphological forms irrespective of their position on the axis.

The Early Development of the Larynx in Staged Human Embryos

More than 15 serially sectioned human embryos from stage 8 to stage 15 were examined, together with relevant reconstructions and photographs. Their lengths ranged from 1 to 7 mm, and their ages from 18 to 33 postovulatory days. The necessity of employing a recognized staging system is stressed. The foregut appears either late in stage 8 or during stage 9. The median pharyngeal groove that appears during stage 9 presages the first indication of the respiratory system and includes the future larynx. The laryngotracheal sulcus begins to be circumscribed at stage 10 and a caudal expansion represents the pulmonary primordium. The tracheoesophageal septum appears at stage 12. The right and left lung buds become definite by stage 13. The hypopharyngeal eminence, arytenoid swellings, and epithelial lamina of the larynx are detectable at stage 14. Vestibulotracheal and pharyngotracheal canals are distinguishable at stage 15. Hence, from the first appearance of the foregut at about 19 days, the larynx has developed into a recognizable organ two weeks later, namely, by 33 days.

The branching programme of mouse lung development

Mammalian lungs are branched networks containing thousands to millions of airways arrayed in intricate patterns that are crucial for respiration. How such trees are generated during development, and how the developmental patterning information is encoded, have long fascinated biologists and mathematicians. However, models have been limited by a lack of information on the normal sequence and pattern of branching events. Here we present the complete three-dimensional branching pattern and lineage of the mouse bronchial tree, reconstructed from an analysis of hundreds of developmental intermediates. The branching process is remarkably stereotyped and elegant: the tree is generated by three geometrically simple local modes of branching used in three different orders throughout the lung. We propose that each mode of branching is controlled by a genetically encoded subroutine, a series of local patterning and morphogenesis operations, which are themselves controlled by a more global master routine. We show that this hierarchical and modular programme is genetically tractable, and it is ideally suited to encoding and evolving the complex networks of the lung and other branched organs.

Laparoscopic retroperitoneal repair of a right-sided Bochdalek hernia

Bochdalek hernias are rare congenital diaphragmatic defects. We report a case of a 50-year-old male with chronic shortness of breath who was diagnosed with a right-sided Bochdalek hernia. This hernia was repaired using a laparoscopic retroperitoneal approach.

Neonatal lung remodeling: structural, inflammatory, and ventilator-induced injury

The developing lung is subject to events, both prenatal and postnatal, that alter the normal developmental process. The degree of insult or injury affects how the lung functions at birth and then responds to the insult throughout childhood. In this article, only 3 of the influences are examined: structural, inflammatory, and mechanical. It is recognized that there is a plethora of other factors that influence lung remodeling.

Systemic to pulmonary collaterals in very low birth weight infants: color doppler detection of systemic to pulmonary connections during neonatal and early infancy period

OBJECTIVE

Angiographic visualization of systemic to pulmonary collaterals (SPC) has been documented in premature infants needing prolonged ventilatory support. Noninvasive identification of such communications in premature infants was reported recently. The purpose of this study was to describe: 1) incidence, 2) clinical findings and implications, and 3) short-term follow-up of SPC diagnosed by echocardiography in very low birth weight (VLBW) infants admitted to the neonatal intensive care unit.

METHODS

From December 1, 1994 to August 31, 1996, 196 infants with birth weight <1500 g were admitted to the neonatal intensive care unit; 133 of them received serial echocardiographic evaluations at 1 to 2 days, at 2 weeks, and at 1, 2, and 3 months of life. Follow-up echocardiograms were scheduled at 6 months and 1 year of age for patients with SPC persisting at 3 months of age.

RESULTS

SPC were demonstrated in 88 patients (66%) at 1 to 90 days of life (mean 28 days). In most cases, the SPC originated at the distal aortic arch or the proximal descending aorta. Ten patients (11%) were treated for congestive heart failure. The symptoms improved and anticongestive therapy was discontinued in 9. One patient with persistent congestive heart failure underwent therapeutic cardiac catheterization and 1 prominent SPC was embolized.

CONCLUSIONS

The incidence of SPC in VLBW infants is much higher than previously reported. We postulate that SPC are bronchopulmonary communications that enlarge and/or proliferate in response to a given stimulus. These communications are associated with increased time on positive pressure ventilation and length of stay in the hospital. SPC may lead to pulmonary edema and should be searched for in VLBW infants with a more complicated course. Echocardiographic examination with color Doppler performed in premature infants to evaluate left to right shunts should include careful search for systemic to pulmonary collaterals.echocardiography, systemic to pulmonary collaterals, aortopulmonary collaterals, prematurity, pulmonary edema.

Development in lung function of the affected side after repair of congenital diaphragmatic hernia

The widespread use of newly developed techniques including extracorporeal membrane oxygenation (ECMO) has led to the survival of a number of patients with congenital diaphragmatic hernia (CDH) and associated hypoplastic lung. However, it is not fully recognized whether the hypoplastic and small lung of the affected side has the ability to develop its function after repair of CDH. The authors studied the lung function of 32 patients with CDH in whom these new methods were used. Two parameters, lung volume and pulmonary perfusion amount, were used to evaluate lung function. The former (checked by computed tomography scan) was used to evaluate the size of lung; the latter (checked by perfusion scintigram) was used to assess vascular density. The patients were divided into two groups, based on values of alveolar-arterial difference in oxygen content (AaDo2) at the time of admission. In group A (AaDo2 < 500 mm Hg; 12 cases), whose respiratory distress was mild and could be managed with ventilator care alone, the mean lung volume value for the affected side was 86% of the contralateral lung value from the initial study, and reached 93% at the time of follow-up study. The perfusion amount also exceeded 80% of the contralateral lung value from the initial study. Thus, it is likely that group A's affected-side lung is not small and has developed at a rate similar to that of the contralateral lung. However, in group B patients (AaDo2 > 500 mm Hg; 20 cases), who had severe respiratory distress at the admission and were managed with new techniques including ECMO, both lung volume and perfusion amount of the affected side initially were low in all cases (ie, mean values were 61% and 53% of contralateral-lung values, respectively). At the time of follow-up, the lung volume had increased in most cases (mean value, 88% of the contralateral lung value), but the perfusion amount of the affected side had not increased in most cases. It remained low, or decreased to below the initial value; the mean was 53% of the contralateral lung value. The initial mean perfusion: volume ratio (87%) had decreased significantly (to 62%) by the time of follow-up. This tendency was exaggerated in the 11 ECMO cases. These data might indicate that in most group B cases, the lung of the affected side has little ability to develop arterial branches, or certainly will be delayed in comparison to the contralateral lung, and that enlargement of lung volume may depend on overexpansion or emphysematous change rather than cellular growth. The present data also suggest that, in group B cases, total lung function will depend on the contralateral lung for a relatively long time.

Small-granule APUD cells in relation to airway branching and growth: a quantitative, cartographic study in Syrian golden hamsters

Small-granule APUD cell clusters and their clear-cell precursors were mapped in serial 2-micron glycol methacrylate-embedded, periodic acid-Schiff (PAS)-lead hematoxylin-stained sections of 13-, 14-, and 15-day fetal hamster lungs. Every sixth section was drawn from a camera lucida projection on tracing paper. Each tracing included the profiles of nonalveolated air passages and the locations of small-granule cell clusters and solitary clear cells. Airways containing ciliated cells and those surrounded by condensed mesoderm were also labeled. Single clear cells were rare in fetal hamster lung. Of 2,368 endocrine cell loci identified in the three fetal age groups examined, only 14 were single clear cells. A preliminary survey of the entire left and right lungs showed that the pattern of airway and small-granule cell development in the infracardiac lobe was similar to that occurring in the remainder of the lung; this lobe was accordingly considered a model for the whole lung, and the ontogeny of its small-granule cell population was quantitated and compared with results of similar quantitative mapping of this lobe in an adult animal (Hoyt et al., 1982a,b). Along the lobar bronchus of the 13-day infracardiac lobe and proximal portions of its main branches, small-granule cell clusters occurred most often near airway intersections. As the number and density increased in subsequent fetal stages, small-granule cell clusters became conspicuous along internodal bronchial segments. In distributing bronchioles, the population density of small-granule cell clusters decreased between 13 and 14 days but more than doubled by day 15. Unlike human lungs, where centrifugally developing small-granule cell clusters are firmly established in terminal bronchioles well before birth, most peripheral bronchioles in fetal hamster were devoid of small-granule cell clusters, even at 15 days, one day before birth. Comparison of numerical population densities in this lobe of fetal and adult lungs indicates that small-granule cell clusters continue to form past day 15 and suggests that they are considerably more numerous in adult than fetal lung.

The early development of the larynx in staged human embryos. I. Embryos of the first five weeks (to stage 15)

More than 15 serially sectioned human embryos from stage 8 to stage 15 were examined, together with relevant reconstructions and photographs. Their lengths ranged from 1 to 7 mm, and their ages from 18 to 33 postovulatory days. The necessity of employing a recognized staging system is stressed. The foregut appears either late in stage 8 or during stage 9. The median pharyngeal groove that appears during stage 9 presages the first indication of the respiratory system and includes the future larynx. The laryngotracheal sulcus begins to be circumscribed at stage 10 and a caudal expansion represents the pulmonary primordium. The tracheoesophageal septum appears at stage 12. The right and left lung buds become definite by stage 13. The hypopharyngeal eminence, arytenoid swellings, and epithelial lamina of the larynx are detectable at stage 14. Vestibulotracheal and pharyngotracheal canals are distinguishable at stage 15. Hence, from the first appearance of the foregut at about 19 days, the larynx has developed into a recognizable organ two weeks later, namely, by 33 days.

Lung hypoplasia in congenital diaphragmatic hernia. A quantitative study of airway, artery, and alveolar development

From a case of congenital diaphragmatic hernia the pattern of growth of the airways, alveoli, and pulmonary arteries of both lungs, each hypoplastic, has been analysed quantitatively. The impairment of growth for each type of structure is not necessarily the same and differs in each lung. Airway and alveolar numbers are both greatly reduced, although the latter are more nearly normal when related to the number of terminal bronchioli in the lung. In each lung the size of the pulmonary artery at the hilum is appropriate to the lung volume but small for the age of the child. Muscle is found in much smaller arteries than is normal but not to a more peripheral level.

The way the lungs in a case of congenital diaphragmatic hernia might grow after surgical correction of the hernia is discussed and a plea made for respiratory physiological studies in such cases.