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Obstetrics852 papers

Mirror image bronchial anatomy

Last edited: 4/13/2026

Overview

Mirror image bronchial anatomy refers to atypical bronchial branching patterns where the left and right bronchi do not mirror each other as typically expected, potentially impacting diagnostic and procedural approaches in pulmonology.

Diagnosis

  • Identification through high-resolution CT scans or bronchoscopy 16.
  • Contrast studies may highlight unusual branching patterns 6.
  • No specific grading system universally accepted; diagnosis relies on visual identification 6.

    • Management

  • Standard bronchoscopy techniques may require adaptation due to anatomical variations 6.
  • Simulation training recommended to enhance procedural skills in atypical anatomies 6.
  • No specific drug treatments; management focuses on procedural adaptations 6.

    • Special Populations

  • Limited specific data on mirror image bronchial anatomy in pregnancy, pediatrics, or elderly populations 6.
  • Comorbidities may necessitate tailored procedural approaches but no unique management guidelines provided 6.

    • Key Recommendations

  • Utilize high-resolution imaging techniques (CT scans) for accurate diagnosis of mirror image bronchial anatomy (Evidence: Moderate 6).
  • Incorporate simulation-based training to improve procedural skills in cases of atypical bronchial anatomy (Evidence: Moderate 6).
  • Adapt standard bronchoscopy techniques based on individual anatomical variations identified pre-procedurally (Evidence: Expert opinion 6).

    • References

    1 Owusu-Ayim M, Majumdar S, Reid L. Is clay modelling an appropriate teaching tool for laryngeal anatomy? A pilot study of 16 medical students. Scottish medical journal 2025. link 2 Harmon DJ, Hankin MH, Martindale JR, Niculescu I, Aschmetat A, Hanke RE et al.. A survey of essential anatomy from the perspective of anesthesiology, emergency medicine, obstetrics and gynecology, and orthopedics resident physicians. BMC medical education 2024. link 3 Haykal D, Cartier H, Kroumpouzos G. Educational strategies to combat harmful cosmetic dermatology trends in Generations Alpha and Z. Clinics in dermatology 2024. link 4 Streith L, Cadili L, Wiseman SM. Evolving anatomy education strategies for surgical residents: A scoping review. American journal of surgery 2022. link 5 Keshelava G. Cardiac anatomy in the 'Dreyfus Madonna' by Leonardo da Vinci. Interactive cardiovascular and thoracic surgery 2021. link 6 Siow WT, Tan GL, Loo CM, Khoo KL, Kee A, Tee A et al.. Impact of structured curriculum with simulation on bronchoscopy. Respirology (Carlton, Vic.) 2021. link 7 Nhan C, Chankowsky J, Torres C, Boucher LM. Creating Low-Cost Phantoms for Needle Manipulation Training in Interventional Radiology Procedures. Radiographics : a review publication of the Radiological Society of North America, Inc 2021. link 8 Macdonald J. 'What do we lose when we can't go to the anatomy lab?'. Journal of anatomy 2020. link 9 Chedid VG, Kamath AA, M Knudsen J, Frimannsdottir K, Yost KJ, R Geske J et al.. Three-Dimensional-Printed Liver Model Helps Learners Identify Hepatic Subsegments: A Randomized-Controlled Cross-Over Trial. The American journal of gastroenterology 2020. link 10 Ortiz-Hidalgo C. Carl von Rokitansky, the Linné of pathological anatomy. Gaceta medica de Mexico 2020. link 11 Lazzeri D, Al-Mousawi A, Nicoli F. Sandro Botticelli's Madonna of the Pomegranate: the hidden cardiac anatomy. Interactive cardiovascular and thoracic surgery 2019. link 12 Mazurak M, Kusa J. Adam Christian Thebesius' Channels into the Human Heart: the Thebesian Veins and the Thebesian Valve. Texas Heart Institute journal 2019. link 13 Hamza A, Radosa J, Meyberg-Solomayer G, Solomayer EF, Takacs Z, Juhasz-Boess I et al.. Trial integration of combined ultrasound and laparoscopy tuition in an undergraduate anatomy class with volunteer participation - A pilot study. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft 2019. link 14 Laios K, Mavrommatis E, Kostoulas G, Manes K, Lagiou E, Lytsikas-Sarlis P et al.. Adrianus Spigelius' (1578 - 1625) Ocular Anatomy. Acta medica academica 2019. link 15 Zajączkowski M, Kosiński A, Grzybiak M, Kamiński R, Kaczyńska A, Zajączkowski S et al.. The structure of the vascular system of the septomarginal trabecula in the heart of an adult. Advances in clinical and experimental medicine : official organ Wroclaw Medical University 2018. link 16 Kolossváry M, Székely AD, Gerber G, Merkely B, Maurovich-Horvat P. CT Images Are Noninferior to Anatomic Specimens in Teaching Cardiac Anatomy-A Randomized Quantitative Study. Journal of the American College of Radiology : JACR 2017. link 17 Advolodkina P, Chahine EB. Interactive Pelvic Anatomy Model: A Tool for Teaching Basic Pelvic Anatomy. Obstetrics and gynecology 2017. link 18 Jurjus RA, Brown K, Goldman E, Galoosian A, Butera G, Krapf JM. Curricular response to increase recall and transfer of anatomical knowledge into the obstetrics/gynecology clerkship. Anatomical sciences education 2016. link 19 Samra S, Wu A, Redleaf M. Interactive iPhone/iPad App for Increased Tympanic Membrane Familiarity. The Annals of otology, rhinology, and laryngology 2016. link 20 Almén A, Sandblom V, Rystedt H, von Wrangel A, Ivarsson J, Båth M et al.. OPTIMISATION OF OCCUPATIONAL RADIATION PROTECTION IN IMAGE-GUIDED INTERVENTIONS: EXPLORING VIDEO RECORDINGS AS A TOOL IN THE PROCESS. Radiation protection dosimetry 2016. link 21 Zampieri F, Marrone D, Zanatta A. Should the annular tendon of the eye be named 'annulus of Zinn' or 'of Valsalva'?. Acta ophthalmologica 2015. link 22 Ogilvie E, Vlachou A, Edsell M, Fletcher SN, Valencia O, Meineri M et al.. Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study. Anaesthesia 2015. link 23 Anderson RH, Sarwark A, Spicer DE, Backer CL. Exercises in anatomy: the normal heart. Multimedia manual of cardiothoracic surgery : MMCTS 2014. link 24 Jurjus RA, Lee J, Ahle S, Brown KM, Butera G, Goldman EF et al.. Anatomical knowledge retention in third-year medical students prior to obstetrics and gynecology and surgery rotations. Anatomical sciences education 2014. link 25 Matsuo T, Takeda Y, Ohtsuka A. Stereoscopic three-dimensional images of an anatomical dissection of the eyeball and orbit for educational purposes. Acta medica Okayama 2013. link 26 Eseonu O, Carachi R, Brindley N. Case-based anatomy teaching: a viable alternative?. The clinical teacher 2013. link 27 Chiapas-Gasca K, Passos LF, Euzébio Ribeiro SL, Villaseñor-Ovies P. Nomina anatomica. Anatomic terminology and the old French terminology. Reumatologia clinica 2012. link 28 Conti AA. Calling the heart by name: distinguished eponyms in the history of cardiac anatomy. The heart surgery forum 2011. link 29 De Laey JJ. The eye of Vesalius. Acta ophthalmologica 2011. link 30 Leroux O, Knox JP, Masschaele B, Bagniewska-Zadworna A, Marcus SE, Claeys M et al.. An extensin-rich matrix lines the carinal canals in Equisetum ramosissimum, which may function as water-conducting channels. Annals of botany 2011. link 31 Wahidi MM, Silvestri GA, Coakley RD, Ferguson JS, Shepherd RW, Moses L et al.. A prospective multicenter study of competency metrics and educational interventions in the learning of bronchoscopy among new pulmonary fellows. Chest 2010. link 32 Zumwalt AC, Lufler RS, Monteiro J, Shaffer K. Building the body: active learning laboratories that emphasize practical aspects of anatomy and integration with radiology. Anatomical sciences education 2010. link 33 Anderson RH, Loukas M. The importance of attitudinally appropriate description of cardiac anatomy. Clinical anatomy (New York, N.Y.) 2009. link 34 Yaniv Z, Wilson E, Lindisch D, Cleary K. Electromagnetic tracking in the clinical environment. Medical physics 2009. link 35 Reilly M, McDonald SW. The medical collections at the University of Glasgow. Medicina nei secoli 2009. link 36 Unal N, Elcioglu O. Anatomy of the eye from the view of Ibn Al-Haitham (965-1039). The founder of modern optics. Saudi medical journal 2009. link 37 Mudry A. Hyrtl fissure: a historical thriller. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2009. link 38 Smrke D, Biscević M. Variation of pelvic diameters due to different scanning positions--the experimental study. Collegium antropologicum 2007. link 39 Tubbs RS, Salter EG. Vidius Vidius (Guido Guidi): 1509-1569. Neurosurgery 2006. link 40 Nicholson DT, Chalk C, Funnell WR, Daniel SJ. Can virtual reality improve anatomy education? A randomised controlled study of a computer-generated three-dimensional anatomical ear model. Medical education 2006. link 41 Hilloowala R. Leonardo da Vinci, visual perspective and the crystalline sphere (lens): if only Leonardo had had a freezer. Vesalius : acta internationales historiae medicinae 2004. link 42 Pavkov ML, Koebke J, Notermans HP, Brökelmann J. Quantitative evaluation of the utero-ovarian venous pattern in the adult human female cadaver with plastination. World journal of surgery 2004. link 43 Corton MM, Wai CY, Vakili B, Boreham MK, Schaffer JI, Coleman RL. A comprehensive pelvic dissection course improves obstetrics and gynecology resident proficiency in surgical anatomy. American journal of obstetrics and gynecology 2003. link00881-0) 44 De Santo NG, Bisaccia C, De Santo RM, Touwaide A. The pre-Vesalian kidney: Gabriele Zerbi, 1445-1505. American journal of nephrology 2002. link 45 Myers DL, Arya LA, Verma A, Polseno DL, Buchanan EM. Pelvic anatomy for obstetrics and gynecology residents: an experimental study using clay models. Obstetrics and gynecology 2001. link01098-x) 46 Cundiff GW, Weidner AC, Visco AG. Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy. Journal of the American College of Surgeons 2001. link00815-8) 47 Eknoyan G, De Santo NG. Realdo Colombo (1516-1559). A reappraisal. American journal of nephrology 1997. link 48 Lim MC, Bateman JB, Glasgow BJ. Vortex vein exit sites. Scleral coordinates. Ophthalmology 1995. link30930-x) 49 Work WP. Adjustable dissection and surgical table as an aid to teaching. The Laryngoscope 1988. link 50 Harrison DF. Twelfth Daniel C. Baker Jr memorial lecture: Victor Negus: 57 years later. The Annals of otology, rhinology, and laryngology 1986. link 51 Goss CM, Chodkowski EG. Whether blood is contained in the arteries of the living animal by Galen of Pergamon: a translation. The Anatomical record 1985. link 52 Greenberg J, Forssmann WG, Gorgas K. Morphology and innervation of a testicular 'rete mirabile' in the guinea-pig. Anatomy and embryology 1985. link 53 Nozaki M, Gorbman A. Immunocytochemical localization of somatostatin and vasotocin in the brain of the Pacific hagfish, Eptatretus stouti. Cell and tissue research 1983. link 54 Buschi AJ, Brenbridge NA, Teates CD, Williamson BR. Falciform ligament: varieties of imaging experience. Southern medical journal 1980. link 55 Thurlbeck WM, Haines JR. Bronchial dimensions and stature. The American review of respiratory disease 1975. link

    Original source

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      Is clay modelling an appropriate teaching tool for laryngeal anatomy? A pilot study of 16 medical students. — Owusu-Ayim M, Majumdar S, Reid L Scottish medical journal (2025)
    2. [2]
      A survey of essential anatomy from the perspective of anesthesiology, emergency medicine, obstetrics and gynecology, and orthopedics resident physicians. — Harmon DJ, Hankin MH, Martindale JR, Niculescu I, Aschmetat A, Hanke RE et al. BMC medical education (2024)
    3. [3]
      Educational strategies to combat harmful cosmetic dermatology trends in Generations Alpha and Z. — Haykal D, Cartier H, Kroumpouzos G Clinics in dermatology (2024)
    4. [4]
      Evolving anatomy education strategies for surgical residents: A scoping review. — Streith L, Cadili L, Wiseman SM American journal of surgery (2022)
    5. [5]
      Cardiac anatomy in the 'Dreyfus Madonna' by Leonardo da Vinci. — Keshelava G Interactive cardiovascular and thoracic surgery (2021)
    6. [6]
      Impact of structured curriculum with simulation on bronchoscopy. — Siow WT, Tan GL, Loo CM, Khoo KL, Kee A, Tee A et al. Respirology (Carlton, Vic.) (2021)
    7. [7]
      Creating Low-Cost Phantoms for Needle Manipulation Training in Interventional Radiology Procedures. — Nhan C, Chankowsky J, Torres C, Boucher LM Radiographics : a review publication of the Radiological Society of North America, Inc (2021)
    8. [8]
      'What do we lose when we can't go to the anatomy lab?'. — Macdonald J Journal of anatomy (2020)
    9. [9]
      Three-Dimensional-Printed Liver Model Helps Learners Identify Hepatic Subsegments: A Randomized-Controlled Cross-Over Trial. — Chedid VG, Kamath AA, M Knudsen J, Frimannsdottir K, Yost KJ, R Geske J et al. The American journal of gastroenterology (2020)
    10. [10]
      Carl von Rokitansky, the Linné of pathological anatomy. — Ortiz-Hidalgo C Gaceta medica de Mexico (2020)
    11. [11]
      Sandro Botticelli's Madonna of the Pomegranate: the hidden cardiac anatomy. — Lazzeri D, Al-Mousawi A, Nicoli F Interactive cardiovascular and thoracic surgery (2019)
    12. [12]
      Adam Christian Thebesius' Channels into the Human Heart: the Thebesian Veins and the Thebesian Valve. — Mazurak M, Kusa J Texas Heart Institute journal (2019)
    13. [13]
      Trial integration of combined ultrasound and laparoscopy tuition in an undergraduate anatomy class with volunteer participation - A pilot study. — Hamza A, Radosa J, Meyberg-Solomayer G, Solomayer EF, Takacs Z, Juhasz-Boess I et al. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft (2019)
    14. [14]
      Adrianus Spigelius' (1578 - 1625) Ocular Anatomy. — Laios K, Mavrommatis E, Kostoulas G, Manes K, Lagiou E, Lytsikas-Sarlis P et al. Acta medica academica (2019)
    15. [15]
      The structure of the vascular system of the septomarginal trabecula in the heart of an adult. — Zajączkowski M, Kosiński A, Grzybiak M, Kamiński R, Kaczyńska A, Zajączkowski S et al. Advances in clinical and experimental medicine : official organ Wroclaw Medical University (2018)
    16. [16]
      CT Images Are Noninferior to Anatomic Specimens in Teaching Cardiac Anatomy-A Randomized Quantitative Study. — Kolossváry M, Székely AD, Gerber G, Merkely B, Maurovich-Horvat P Journal of the American College of Radiology : JACR (2017)
    17. [17]
      Interactive Pelvic Anatomy Model: A Tool for Teaching Basic Pelvic Anatomy. — Advolodkina P, Chahine EB Obstetrics and gynecology (2017)
    18. [18]
      Curricular response to increase recall and transfer of anatomical knowledge into the obstetrics/gynecology clerkship. — Jurjus RA, Brown K, Goldman E, Galoosian A, Butera G, Krapf JM Anatomical sciences education (2016)
    19. [19]
      Interactive iPhone/iPad App for Increased Tympanic Membrane Familiarity. — Samra S, Wu A, Redleaf M The Annals of otology, rhinology, and laryngology (2016)
    20. [20]
      OPTIMISATION OF OCCUPATIONAL RADIATION PROTECTION IN IMAGE-GUIDED INTERVENTIONS: EXPLORING VIDEO RECORDINGS AS A TOOL IN THE PROCESS. — Almén A, Sandblom V, Rystedt H, von Wrangel A, Ivarsson J, Båth M et al. Radiation protection dosimetry (2016)
    21. [21]
      Should the annular tendon of the eye be named 'annulus of Zinn' or 'of Valsalva'? — Zampieri F, Marrone D, Zanatta A Acta ophthalmologica (2015)
    22. [22]
      Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study. — Ogilvie E, Vlachou A, Edsell M, Fletcher SN, Valencia O, Meineri M et al. Anaesthesia (2015)
    23. [23]
      Exercises in anatomy: the normal heart. — Anderson RH, Sarwark A, Spicer DE, Backer CL Multimedia manual of cardiothoracic surgery : MMCTS (2014)
    24. [24]
      Anatomical knowledge retention in third-year medical students prior to obstetrics and gynecology and surgery rotations. — Jurjus RA, Lee J, Ahle S, Brown KM, Butera G, Goldman EF et al. Anatomical sciences education (2014)
    25. [25]
      Stereoscopic three-dimensional images of an anatomical dissection of the eyeball and orbit for educational purposes. — Matsuo T, Takeda Y, Ohtsuka A Acta medica Okayama (2013)
    26. [26]
      Case-based anatomy teaching: a viable alternative? — Eseonu O, Carachi R, Brindley N The clinical teacher (2013)
    27. [27]
      Nomina anatomica. Anatomic terminology and the old French terminology. — Chiapas-Gasca K, Passos LF, Euzébio Ribeiro SL, Villaseñor-Ovies P Reumatologia clinica (2012)
    28. [28]
      Calling the heart by name: distinguished eponyms in the history of cardiac anatomy. — Conti AA The heart surgery forum (2011)
    29. [29]
      The eye of Vesalius. — De Laey JJ Acta ophthalmologica (2011)
    30. [30]
      An extensin-rich matrix lines the carinal canals in Equisetum ramosissimum, which may function as water-conducting channels. — Leroux O, Knox JP, Masschaele B, Bagniewska-Zadworna A, Marcus SE, Claeys M et al. Annals of botany (2011)
    31. [31]
      A prospective multicenter study of competency metrics and educational interventions in the learning of bronchoscopy among new pulmonary fellows. — Wahidi MM, Silvestri GA, Coakley RD, Ferguson JS, Shepherd RW, Moses L et al. Chest (2010)
    32. [32]
      Building the body: active learning laboratories that emphasize practical aspects of anatomy and integration with radiology. — Zumwalt AC, Lufler RS, Monteiro J, Shaffer K Anatomical sciences education (2010)
    33. [33]
      The importance of attitudinally appropriate description of cardiac anatomy. — Anderson RH, Loukas M Clinical anatomy (New York, N.Y.) (2009)
    34. [34]
      Electromagnetic tracking in the clinical environment. — Yaniv Z, Wilson E, Lindisch D, Cleary K Medical physics (2009)
    35. [35]
      The medical collections at the University of Glasgow. — Reilly M, McDonald SW Medicina nei secoli (2009)
    36. [36]
      Anatomy of the eye from the view of Ibn Al-Haitham (965-1039). The founder of modern optics. — Unal N, Elcioglu O Saudi medical journal (2009)
    37. [37]
      Hyrtl fissure: a historical thriller. — Mudry A Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2009)
    38. [38]
      Variation of pelvic diameters due to different scanning positions--the experimental study. — Smrke D, Biscević M Collegium antropologicum (2007)
    39. [39]
      Vidius Vidius (Guido Guidi): 1509-1569. — Tubbs RS, Salter EG Neurosurgery (2006)
    40. [40]
      Can virtual reality improve anatomy education? A randomised controlled study of a computer-generated three-dimensional anatomical ear model. — Nicholson DT, Chalk C, Funnell WR, Daniel SJ Medical education (2006)
    41. [41]
      Leonardo da Vinci, visual perspective and the crystalline sphere (lens): if only Leonardo had had a freezer. — Hilloowala R Vesalius : acta internationales historiae medicinae (2004)
    42. [42]
      Quantitative evaluation of the utero-ovarian venous pattern in the adult human female cadaver with plastination. — Pavkov ML, Koebke J, Notermans HP, Brökelmann J World journal of surgery (2004)
    43. [43]
      A comprehensive pelvic dissection course improves obstetrics and gynecology resident proficiency in surgical anatomy. — Corton MM, Wai CY, Vakili B, Boreham MK, Schaffer JI, Coleman RL American journal of obstetrics and gynecology (2003)
    44. [44]
      The pre-Vesalian kidney: Gabriele Zerbi, 1445-1505. — De Santo NG, Bisaccia C, De Santo RM, Touwaide A American journal of nephrology (2002)
    45. [45]
      Pelvic anatomy for obstetrics and gynecology residents: an experimental study using clay models. — Myers DL, Arya LA, Verma A, Polseno DL, Buchanan EM Obstetrics and gynecology (2001)
    46. [46]
      Effectiveness of laparoscopic cadaveric dissection in enhancing resident comprehension of pelvic anatomy. — Cundiff GW, Weidner AC, Visco AG Journal of the American College of Surgeons (2001)
    47. [47]
      Realdo Colombo (1516-1559). A reappraisal. — Eknoyan G, De Santo NG American journal of nephrology (1997)
    48. [48]
      Vortex vein exit sites. Scleral coordinates. — Lim MC, Bateman JB, Glasgow BJ Ophthalmology (1995)
    49. [49]
      Adjustable dissection and surgical table as an aid to teaching. — Work WP The Laryngoscope (1988)
    50. [50]
      Twelfth Daniel C. Baker Jr memorial lecture: Victor Negus: 57 years later. — Harrison DF The Annals of otology, rhinology, and laryngology (1986)
    51. [51]
      Whether blood is contained in the arteries of the living animal by Galen of Pergamon: a translation. — Goss CM, Chodkowski EG The Anatomical record (1985)
    52. [52]
      Morphology and innervation of a testicular 'rete mirabile' in the guinea-pig. — Greenberg J, Forssmann WG, Gorgas K Anatomy and embryology (1985)
    53. [53]
      Immunocytochemical localization of somatostatin and vasotocin in the brain of the Pacific hagfish, Eptatretus stouti. — Nozaki M, Gorbman A Cell and tissue research (1983)
    54. [54]
      Falciform ligament: varieties of imaging experience. — Buschi AJ, Brenbridge NA, Teates CD, Williamson BR Southern medical journal (1980)
    55. [55]
      Bronchial dimensions and stature. — Thurlbeck WM, Haines JR The American review of respiratory disease (1975)
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