Case report: Endotracheal tube malposition in a patient with a tracheal bronchus

Wong, David T.; Kumar, Ashok

doi:10.1007/bf03022798

Cited by 28 publications

(29 citation statements)

References 14 publications

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“…The Dutch professor of anatomy, Edward Sandifort first described tracheal bronchus in 1785 [6,14]. This anomaly involves a bronchus arising from the lateral wall of the trachea.…”

Section: Discussionmentioning

confidence: 99%

“…A tracheal bronchus can be associated with other congenital anomalies, such as Down syndrome, tracheal stenosis and tracheoesophageal fistula, and cyanotic heart disease, but it is usually asymptomatic and may remain unknown. The ETT can migrate into a tracheal bronchus and obstruct an ectopic bronchus, causing atelectasis, profound hypoxemia, or hyperinflation of the corresponding lobe, with the risk of barotraumas [4][5][6][7]. Recognition of this anomaly before the intubation allows placement of the ETT safely above the tracheal bronchus and prevention of adverse respiratory events.…”

Section: Discussionmentioning

confidence: 99%

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Inability to ventilate the lungs of a patient with tracheal anomaly and in prone position

Sripada

Keys

Eichholz

2008

Journal of Clinical Anesthesia

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“…The Dutch professor of anatomy, Edward Sandifort first described tracheal bronchus in 1785 [6,14]. This anomaly involves a bronchus arising from the lateral wall of the trachea.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inability to ventilate the lungs of a patient with tracheal anomaly and in prone position

Sripada

Keys

Eichholz

2008

Journal of Clinical Anesthesia

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“…Although it is reported that careful preoperative observation of chest X-rays can identify a tracheal bronchus [7,21], the diffi culty in diagnosis arises when the tracheal bronchus overlaps the mediastinal shadow on the chest X-ray, as occurred in our patient. Tracheal bronchus is well diagnosed with chest CT [2,9,10,15,22]. Spiral CT has especially broadened the potential of the imaging of lung anatomy by offering various reformation techniques, including multiplanar reconstruction, 3D reconstruction, shadedsurface display, and virtual bronchoscopy [2].…”

Section: D Image Reconstruction Analysismentioning

confidence: 99%

“…A tracheal bronchus can arise anywhere between the carina and cricoid cartilage [15], but is usually within 2 cm of the carina [2] and up to 6 cm from the carina [16,17]. An upper-lobe bronchus (type II) can be potentially obstructed by an endotracheal tube, resulting in atelectasis and shunting [7].…”

Section: D Image Reconstruction Analysismentioning

confidence: 99%

Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation

et al. 2009

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The incidence of a tracheal bronchus--that is, a congenitally abnormal bronchus originating from the trachea or main bronchi--is 0.1%-2%. Serious hypoxia and atelectasis can develop in such patients with intubation and one-lung ventilation. We experienced a remarkable decrease in peripheral oxygen saturation (SpO2) and a rise in airway pressure during placement of a double-lumen endobronchial tube in a patient with patent ductus arteriosus and tracheal bronchus. Substitution of the double-lumen tube with a bronchial blocker tube provided secure isolation of the lung intraoperatively. A type I tracheal bronchus and segmental tracheal stenosis were identified on postoperative three-dimensional (3D) computed tomographic (CT) images. Preoperative examination of chest X-rays, CT images, and preoperative tracheal 3D images should preempt such complications and assist in securing safe and optimal one-lung ventilation.

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“…However, supernumerary or displaced bronchi can also exist and complicate the placement of airway stents [2]. There are case reports of complications occurring after airway intubation in patients with anatomical variations [3,4,5]. In addition, normal airway tapering from proximal to distal can also preclude the placement of a standard commercially available stent.…”

Section: Introductionmentioning

confidence: 99%

On-Site Customization of Silicone Stents: Towards Optimal Palliation of Complex Airway Conditions

Breen

Dutau²

2009

Respiration

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Background: Stents may be indicated as treatment of benign and malignant conditions of the central airways. Occasionally, aberrant and/or distorted airways secondary to therapy or surgery may preclude the use of commercially manufactured stents. The customization of stents is well described for nonpulmonary diseases, but to date there are only limited data in the literature on prosthesis customization for airway disease. Objectives: To review all the different techniques and indications of on-site silicone stent customizations and their related complications. Methods: A retrospective study was undertaken to identify all patients who underwent treatment with a silicone stent which was customized on site by the physician. The study included subjects treated during an 8-year period. Results: Forty-nine on-site customizations were performed in 43 patients (34 males, mean age 63 ± 5.2 years). Stent customization was performed in 5.4% of the cases. Stent customization was performed for malignant and benign disease in 35 (81.3%) and 8 (18.7%) cases, respectively. In all cases, the stent deployed successfully and performed well while in situ. Stent manipulation did not increase complications. Conclusions: Customization of airway stents by the physician can lead to successful stenting of difficult airway lesions with a good short-term safety profile. Standard commercially available stents may have resulted in suboptimal management of complex airway pathologies. A prospective study is warranted to further investigate the safety profile and complications associated with stent customization.

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Case report: Endotracheal tube malposition in a patient with a tracheal bronchus

Cited by 28 publications

References 14 publications

Inability to ventilate the lungs of a patient with tracheal anomaly and in prone position

Inability to ventilate the lungs of a patient with tracheal anomaly and in prone position

Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation

On-Site Customization of Silicone Stents: Towards Optimal Palliation of Complex Airway Conditions

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