The Anatomy of the Blood Vessels of the Human Lung as Applied to Chest Radiology Parts I, II, and III

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Abstract
After a historical introduction the author describes the three methods he used to study the anatomy of the blood vessels of the human lung: the production of celloidin models, radiography of lung following injection of the vessels with barium sulphate suspension, and tomography of the living subject. The arterial system of the lung follows on the whole the bronchial, but variations in the former are more common than in the latter. These variations may be variations of origin, of duplication, of size and direction. But in any case, there is a typical ground plan of the pulmonary vessels similar to the arrangement of the bronchi, upon which the variations may be grafted. Variations are most common in the upper lobe and may be classified into 2 main types: the "tree type" and the "bush type." In contrast to the arteries, the veins tend to be distant from the bronchi, cross the bronchi at an angle, but are never parallel with them. The anatomy of the branches and tributaries of pulmonary arteries and veins is discussed in detail. The terminology follows essentially Ewart with modifications from Herrnheiser. In the third part of the article the author attempts to correlate the anatomy of the lung vessels with their X-ray appearance. It was possible to recognize and name the majority of the first and second order branches from the roentgenogram. Author lists the following characteristics of a blood vessel shadow: it is found in a position normally occupied by a vessel; it appears to proceed toward the hilum of the lung and its direction corresponds to that of a known vessel; it shows a gradual diminution in caliber in proportion to its distance from the hilum; it maintains a constant relationship to an accompanying bronchus; it is either straight or gently curved, but never tortuous; any tributaries which arise from it have a diameter less than that of the parent vessel; it is moderately dense with clearly defined edges; when seen end-on, the shadow is a regular circle or ellipse and its diameter is similar to that of a nearby vessel seen length-ways-on; in addition it presents a homogeneous opacity and an accompanying bronchus can frequently be seen also end-on. Veins present in general a less dense and less clear-cut but wider shadow than the corresponding arteries.

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