Anesthetic experience of an adult patient with an unrecognized tracheal bronchus -A case report-

Abstract

We present a case of problematic tracheal intubation in an adult patient with an unrecognized tracheal bronchus. Immediately after tracheal intubation and position change to prone, bilateral breath sounds were almost absent, and there was a diminished tidal volume. In order to resolve the ventilatory difficulty, the wire-reinforced tube was replaced with a conventional tube, and proper positioning of the tube was completed under fiberoptic guidance. A tracheal bronchus (originating about 1.2 cm above the carina, and supplying the right upper lobe) was found on the postoperative chest CT. In the presence of tracheal bronchus, tracheal intubation may cause pulmonary complications. Anesthesiologists should keep in mind the anesthetic implications of tracheal bronchus, and must be familiar with the use of fiberoptic bronchoscopy for proper positioning of endotracheal tube.

Tracheal Bronchus Presenting with Recurrent Haemoptysis in an Adult Female

“…Unrecognised intubation of a tracheal bronchus can cut off the ventilation to the rest of the lung resulting in low tidal volume, hypoxaemia and respiratory acidosis; whereas bypassing the accessory bronchus during intubation may result in postoperative collapse of the lung ventilated by the tracheal bronchus [7,8]. Occasionally, cases of lung cancer, carcinoid tumour and squamous cell carcinoma arising from the tracheal bronchus have been reported [9][10][11].…”

Powtarzające się krwioplucie u dorosłej kobiety z oskrzelem tchawiczym

“…Istnienie oskrzela tchawiczego ma duże znaczenie w przypadku planowego lub nagłego znieczulenia. Intubacja oskrzela tchawiczego może odciąć dopływ tlenu do reszty płuc, skutkując niską objętością oddechową, niedotlenieniem krwi i kwasicą oddechową, natomiast ominięcie dodatkowego oskrzela podczas intubacji może spowodować pooperacyjne zapadnięcie się płuca zaopatrywanego przez oskrzele tchawicze [7,8]. Opisano także przypadki raka płuc, rakowiaka i raka płaskokomórkowego, które powstały w oskrzelu tchawiczym [9][10][11].…”