An Anomalous Human Lung, having 
Four Lobes on the Right Side. 
I 
BY 
WILLIAM A. EDWARDS, M. D., 
Assistant Demonstrator of Clinical Medicine in the University of Pennsylvania : 
Medical Registrar, Philadelphia Hospital. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
July, 1885. Extracted from the 
American Journal of the Medical .Sciences for July, 1885. 
AN ANOMALOUS HUMAN LUNG, HAYING FOUR 
LOBES ON THE RIGHT SIDE.1 
By WILLIAM A. EDWARDS, M.D., 
Assistant Demonstrator of Clinical Medicine in the University of Pennsylvania ; 
Medical Registrar, Philadelphia Hospital. 
Mary 0., Irish by birth, ast. 62, widow, mother of four children, came 
under my care just a year ago, suffering from some slight ailments in- 
evitable at her period of life. The patient’s vital powers were at a low 
ebb, and she finally succumbed to senile asthenia two and a half months 
after I first saw her. A post-mortem examination was made, not of 
course to verify the ante-mortem diagnosis, but in the routine line of 
duty ; our work was rewarded by securing this extremely interesting and 
unique specimen. All the organs were destitute of marked pathological 
lesions, but upon opening the thorax an unusual condition of affairs was 
made apparent, well illustrated in the accompanying drawing, in which the 
lungs are represented as widely stretched apart, increasing the mediastinal 
space by several inches, thus exposing the heart and great vessels, and 
giving a better view of the accessory lobe. 
The left lung did not deviate from the normal standard, but the right 
presented four well-marked lobes, as shown in the accompanying drawing. 
The upper lobe was normal, bearing the proper relative proportion to 
the remaining parenchyma ; the middle lobe was somewhat decreased in 
size, as was also the lower, and between the two may be seen the anoma- 
lous fourth lobe, which was formed at the expense of the second and third 
lobes together with an absolute increase of lung tissue, as the other lobes 
are not diminished enough to form the new lobe. 
This supernumerary lobe was quite as long as a man’s hand from the 
wrist to the tip of the second finger, measuring from six and a half to 
seven inches. 
At its widest part it measured two and a quarter inches, tapering to a 
quarter of an inch, and finally to the thin border as in the other parts. Its 
1 Exhibited before the Philadelphia Pathological Society, A.pril 9, 1885. 2 
tissue was perfectly normal and functionally active. Its histological struc- 
ture was the same as the rest of the lung, and it apparently did its work 
equally as well. 
It is almost needless to remark that no evidence of this condition was 
revealed ante-mortem, nothing had ever called attention to the lungs, and 
of course the diagnosis could not have been made even by the most expert 
and careful diagnostician. 
In illustration of the rarity of this anomaly, I am able to cite the 
following authorities :— 
Prof. Joseph Leidy writes me “ I have never seen such a lung, nor do 
I remember having read of one.” Prof. William Pepper “ has never 
seen such a case, and recalls no record of one.” Prof. William Osier 
“ cannot recollect a similar case occurring under my observation,” but 
sends me a record of the following anomalies :— 
“ Case I. In which the right middle lobe was only a notch, the lung 
having but two lobes on the right side. 3 
“ Case II. The upper lobe of the left lung was divided by a deep 
fissure extending internally nearly to the root. Anteriorly to within an 
inch and a half of the usual fissure. Another fissure was noted in the 
same lobe three inches from the apex.” 
It will thus be seen that the left lung in this case was made up of three 
lobes, the deviation from the normal standard being at the expense of the 
upper lobe entirely. Dr. H. F. Formad “ has seen a lung presenting 
three lobes on each side, but never one as above described.” Prof. J. M. 
Da Costa “ has never seen a similar case.” Dr. W. S. Forbes writes that 
“ In a long experience with the cadaver I have never met such an 
anomaly.” 
A careful search through a number of anatomical works failed to reveal 
a like condition, with one or two exceptions, for example, the magnificent 
work of Braune (Topographisch Anatomischer Atlas, Dr. Med. Will). 
Braune, Leipzig, 1875), where a number of thoracic abnormalities are 
depicted, a case like ours receives no mention. Wm. Cowper (Anatomy 
of the Human Body, London, 1697, Table xxiv.) describes but two 
lobes to each lung, calling them the right and left anterior lobes, and the 
right and left posterior lobes. Weckel (Handbuch der Path. Anat., Bd. 
i. page 479) remarks that Rhodius states that Mollinetta (Mantissa Anat. 
Ohser. xi.) once found in a very large man the lungs divided into four 
lobes like the ruminants. The Anatomy of Harrison Allen devotes more 
space to these anomalies than most other anatomical works, although even 
here it is but a few lines. 
Dr. Collins (On Accessory Lobes of the Human Lungs, by Edw. W. 
Collins, M.D., Trans. Royal Irish Academy, vol. xxv. part vii. p. 329, 
Dublin, April 13, 1874) records a threefold abnormality in the right 
lung, pleura and vena azygos. Immediately above the posterior part of 
the root, in the angle between it and upper portion of the right lung, was 
to be seen an accessory lobe, somewhat pyriform in shape, with a broad 
peduncular attachment. Its measurements were four inches in length by 
two and a half in breadth at its widest part. Breadth of peduncle is one 
and a half inches. The lobe laid beside and upon the bodies of the five 
upper dorsal vertebrae in an accessory pleural pouch, which communicated 
with the general pleural cavity around the peduncle of the lobe. The 
pleural duplicate was continuous with the costal portion of the pleura 
above and along its outer border; along its inner border with the medias- 
tinal. Its lower border alone was free ; the inner free margin contained 
the azygos vein, this vein had an anomalous distribution, the course of 
which it is not necessary to describe. The trachea was separated from 
the spinal column for a considerable space by the pleural pouch. 
H. A. Wrisberg, in 1777, laid before the Royal Society of Gottingen an 
anomaly similar to the one above recorded. (Cf. Observationes Anato- 
mic® de vena azyga duplici aliisque hujus ven® varietatibus, in Novis 4 
Commentariis Soc. Reg. Scient., Gottingen, anno 1777, tom. viii. p. 14.) 
Bouchaud put on record another case before the Anatomical Society of 
Paris, in 1862. 
Lately four instances of accessory lobes above the root of the right 
lung have been noted by Dr. Chiene in Edinburgh, Prof. Cleland in 
Galway, and Prof. Wenzell Gruber in St. Petersburgh. 
Wrisberg’s case is worthy of special note as being the only recorded 
instance of an accessory lobe of the left vena azygos. Prof. Cleland 
explains the fact of the accessory lobe appearing on the right side, which 
appears to be consonant with the development of the venous system as 
follows : Early in foetal life from some such cause as a slight adhesion of 
the lung to thoracic wall, or less probably, an undue curvature of the 
embryo, the azygos vein as it is drawn downwards at a right angle to its 
original transverse direction by the descent of the heart, dragged down 
around it a fold of the pleura, thus deeply notching the lung instead of 
slipping behind it. 
Comparative anatomists, says Collins, from the time of Cruvier, have 
shown that a fourth lobe upon the right side, which makes its first appear- 
ance in many of the quadrumana, is very constantly found in other mam- 
mals occupying a defined position, between the pericardium and diaphragm 
in one direction, and between the inferior vena cava and the spine in the 
other, a position due to the altered situation of the pericardium. 
An accessory lobe of the right lung in man lying below the root on the 
inner side, and bearing a tolerably strict homology to this so-called lobus 
impar, which has been regarded by some zoologists as forming a distinctive 
difference between the lungs of quadrupeds and man, has been made the 
subject of a memoir by M. Pozzi ( Cf. Revue d’ Anthropologie dirigee, par 
P. Broca, 1872, p. 443), and was the only case on record in man, prior 
to my describing this second case. 
A similarily situated accessory lobe upon the left side has been des- 
cribed in detail by Prof. Iiektorzik of Vienna ( Cf. Zeitschrift der K. K. 
Gesellschaft der Aerzte der Wien, 1861, No. 1). This accessory lobe 
was wholly isolated from the remainder of the lung, unexpanded, having 
no connection with the bronchus, though it contained collapsed alveoli, 
and bronchia lined with ciliated epithelium. It was from a girl who sur 
vived her birth only fourteen days. 
In Prof. Wenzell Gruber’s case besides the accessory lobe of the vena 
azygos, the remainder of the right lung was divided into four lobes by a 
cruciform fissure. 
Mr. Laurance Humphrey exhibited before the Cambridge Medical 
Society1 an abnormal structure, which he had removed from the body of 
a child a year old who died of tubercular meningitis and acute general 
1 British Med. Journal, April 25, 1885, p. 842. 5 
tuberculosis. It was lying in the left pleural cavity, in the vertebral groove 
between the base of the lung and the diaphragm, and was suspended by a 
thin pedicle of bloodvessels and connective tissue to the descending aorta, 
from which it received its blood supply. It had no connection whatever 
with the lung, neither was there any communication with or attachment 
to any part of the air-passage. It measured about two inches long by one 
broad; was flattened at the posterior surface, and rounded anteriorly, and 
had the appearance of a foetal lung, but was much harder. Sections 
under the microscope showed lung tissue containing bronchioles lined 
with columnar epithelium, and thick-walled unexpanded air-vesicles, with 
a plentiful supply of bloodvessels ; also large masses of caseating tubercle 
with well-marked giant cells. 
H. Handford1 records a case of a man, get. 40, who died from chronic 
epilepsy. At the autopsy the following condition was revealed : Lying 
upon the pericardium and distinct from the rest of the lung about one 
inch and a half, was a lobe of lung tissue one inch and a quarter long, 
three-quarters broad, and nearly one-half thick in the centre. It was 
attached to the anterior margin of the upper part of the lower lobe of the 
left lung by a double fold of pleura, in which were a few vessels. It was 
light in color, and not much pigmented. It contained plenty of air. No 
microscopic examination was made. 
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