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Topic

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Lingular vein of left lung

The lingular vein is a major tributary of the left superior pulmonary vein (LSPV), draining the lingular segments (S4 – superior lingular, and S5 – inferior lingular) of the left upper lobe. Anatomically, the lingula of the left lung is the functional equivalent of the right middle lobe, and its venous drainage mirrors the middle lobe vein on the right side.

The lingular vein typically forms by the confluence of the superior lingular vein (V4) and the inferior lingular vein (V5), coursing medially to join the LSPV near its ostium into the left atrium. Variations are common, with the lingular vein sometimes draining independently into the left atrium or forming a common trunk with other segmental veins of the left upper lobe.

Clinically, the lingular vein is important in atrial fibrillation ablation, where precise mapping of pulmonary venous ostia is required, and in segmentectomy or lobectomy for lung cancer surgery.

Synonyms

  • Left lingular segmental vein

  • Lingular tributary of LSPV

  • Lingular pulmonary vein

Function

  • Drains oxygenated blood from the superior (S4) and inferior (S5) lingular segments of the left upper lobe

  • Contributes to venous return via the LSPV → left atrium pathway

  • Provides anatomic landmarks for surgical resections and AF ablation planning

Tributaries

  • Superior lingular vein (V4) – drains segment S4

  • Inferior lingular vein (V5) – drains segment S5

MRI Appearance

T1-weighted images:

  • Lingular vein appears as a signal void (black lumen) adjacent to segmental bronchi/arteries

  • Surrounded by hyperintense hilar fat, aiding delineation

T2-weighted images (normal):

  • Seen as a dark linear lumen with surrounding bright lung parenchyma

  • Intraluminal thrombus may appear intermediate-to-hyperintense

T2 TRUFISP (cardiac/respiratory-gated):

  • Lingular vein appears as a bright, continuous venous channel joining the LSPV

  • Cine-like images depict flow and venous confluence

STIR:

  • Suppresses fat to improve visualization of lingular venous course through hilar tissue

  • Perivascular edema/inflammation becomes hyperintense

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • Lingular vein enhances homogeneously with contrast

  • Filling defects correspond to thrombosis, stenosis, or compression

MRI Non-Contrast 3D Cardiac-Gated Imaging (whole-heart):

  • Provides high-resolution 3D visualization of V4 + V5 confluence → LSPV

  • Critical for pre-ablation pulmonary venous mapping and surgical planning in patients contraindicated for contrast

CT Appearance

CT Coronary Angiography (CCTA) / CT Pulmonary Venography:

  • Contrast-enhanced CT depicts the superior and inferior lingular veins uniting into the LSPV

  • Multiplanar and 3D reconstructions define ostial anatomy, common trunks, and drainage variants

  • Detects anomalous drainage, narrowing, or thrombus

  • Essential for atrial fibrillation ablation planning, lung segmentectomy, and oncologic staging

CT images

Lingular vein of left lung anatomy CT axial image -img-00000-00000

MRI images

Inferior lingular vein of left lung mri axial image