Challenging Lung Isolation Secondary to Aberrant Tracheobronchial Anatomy

Wiser, Sarah H.; Hartigan, Philip M.

doi:10.1213/ane.0b013e318206917a

Cited by 26 publications

(23 citation statements)

References 14 publications

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“…Typically, patients with TB can be well managed with a left DLT [3,4]. If a left DLT is not adequate, other potential solutions, including the use a Fogarty catheter to block the TB in addition to a Univent tube [5], only a Univent tube or one BB blocking of a TB [6-8] or the use a Fogarty catheter in the TB with BB located in the right main bronchus [8]. The normal RUL bronchus arises from 1-3 cm, distal to the carina; otherwise, TB is usually 2 cm above the carina [1].…”

Section: Discussionmentioning

confidence: 99%

Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-

Lee

Kim

et al. 2013

Korean J Anesthesiol

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Tracheal bronchus (TB) is an aberrant, accessary or ectopic bronchus arising almost exclusively from the right side of the tracheal wall above the carina. In our center, 673 bronchoscopic examinations were performed from 2009 to 2011 in patients undergoing one lung ventilation (OLV) and 3 TB were found. The incidence of a TB at bronchoscopy was 0.45% in our research, which is consistent with the reported incidence range from 0.1-5%. The clinician should consider the possibility of anomalous right upper lobe bronchus and perform bronchoscopy prior to the right bronchial blocker insertion, when left-sided OLV using bronchial blocker is planned. Also, for the patient with TB, a double lumen tube insertion is recommended than a blocker insertion to achieve OLV completely.

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Section: Discussionmentioning

confidence: 99%

Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-

Lee

Kim

et al. 2013

Korean J Anesthesiol

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“…10 Nevertheless, there are reports showing that use of a DLT failed to achieve OLV because of a left-shifted carina and an apically retracted left main bronchus, even though the tracheal bronchus was within 2 cm of the carina. 11,12 In our case, the margin of safety to position the tracheal lumen of the DLT could not be assured because of the higher than usual take-off of the tracheal bronchus. 7 Use of a bronchial blocker allowed OLV regardless of the anatomical distortion and bronchial diameter.…”

Section: Discussionmentioning

confidence: 69%

“…13 Use of a number of different bronchial blocker systems have been reported in patients with a tracheal bronchus requiring OLV. 6,11 In the present case, we thought that the Arndt system would be useful because the bronchial blocker had to pass through a bifurcation site twice in order to reach the left main bronchus; thus, it might have been more difficult to place a bronchial blocker without any intrinsic wire guidance. Other types of bronchial blockers, such as the Cohen Flexitip (Cook, Bloomington, IN, USA) and the Fuji Uniblocker (Fuji Systems, Tokyo, Japan) can be used to achieve OLV, but the procedure might be technically difficult and more time-consuming.…”

Section: Discussionmentioning

confidence: 82%

The implications of a tracheal bronchus on one-lung ventilation and fibreoptic bronchoscopy in a patient undergoing thoracic surgery: a case report

Moon

Kim

Lee

2014

Can J Anesth/J Can Anesth

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Purpose Due to its anatomical complexity, a tracheal bronchus has important clinical implications for one-lung ventilation (OLV). We present a case of successful OLV in a patient with a high a type I (i.e., high take-off) tracheal bronchus. This anomaly presented unusual fibreoptic bronchoscopic (FOB) views that were difficult to discern from the normal carinal bifurcation. Clinical features A 35-yr-old male presented for posterior basal segmentectomy of the left lower lobe under video-assisted thoracoscopy. The preoperative chest radiography was reported as normal, but a computed tomography scan of the chest revealed a right upper lobe tracheal bronchus. The inlet of the tracheal bronchus was located high above the carina, and the distal trachea had significant narrowing. Because the main trachea was divided into a tracheal bronchus and a distal trachea with similar diameters and with an acute angle of divergence, FOB views of the tracheal bronchus take-off appeared similar to the normal carinal bifurcation. Moreover, the actual carina had an atypical appearance with the main bronchi shifted laterally and a blunted carinal ridge. As a result of this atypical tracheobronchial anatomy, we used an Arndt endobronchial blocker system instead of a double-lumen tube (DLT) for right-sided OLV. One-lung ventilation was satisfactory throughout the uncomplicated operation. Conclusion Careful preoperative assessment of tracheobronchial anatomy is imperative in order to choose an appropriate method of OLV and prevent potential complications. In a type I tracheal bronchus with a narrowed distal trachea, a bronchial blocker may have advantages over the conventional DLT in achieving OLV. RésuméObjectif Compte tenu de sa complexité anatomique, une bronche trachéale a d'importantes implications cliniques sur la ventilation à un seul poumon (OLV). Nous présentons un cas d'OLV réussie chez un patient ayant un type I haut, c'est-à-dire un embranchement haut-situé de la bronche trachéale. En bronchoscopie à fibre optique (FOB), cette anomalie présentait des images peu communes difficiles à discerner d'une carène de bifurcation normale. Caractéristiques cliniques Un homme âgé de 35 ans a été hospitalisé pour segmentectomie basale postérieure du lobe inférieur gauche par thoracoscopie assistée par vidéo. La radiographie préopératoire du thorax a été décrite comme normale, mais une tomodensitométrie du thorax a révélé une bronche trachéale du lobe supérieur droit. Le départ de la bronche trachéale était situé haut par rapport à la carène et la trachée distale était significativement rétrécie. Dans la mesure où la trachée proprement dite se divisait en bronche trachéale et en trachée distale, aux Author contributions Young-Jin Moon and Sung-Hoon Kim were responsible for the conception of the case report and writing the manuscript. Sang-Wook Park and Yu-Mi Lee were involved in anesthetic management of the patient and also gave important suggestions during manuscript preparation.

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“…However, intubation di culties, hypoxemia, inability to perform a one-lung ventilation, and high airway pressure often occur during surgery. An ectopic bronchus arising from the trachea to one or several segments of the bronchus is an uncommon reason [1]. We report a case of the di culty performing a DLT intubation due to a tracheal bronchus (TB).…”

Section: Introductionmentioning

confidence: 99%

Difficulty Intubating a Double-Lumen Tube due to a Tracheal Bronchus: A Case Report

Wang

Liu

et al. 2021

Preprint

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Background: Intubation difficulties, hypoxemia, inability to perform a one-lung ventilation, and high airway pressure often occur during double-lumen tube intubation. Tracheal bronchus is a very rare and difficult to find reason. We present a case of tracheal bronchus accidentally discovered during double-lumen tube intubation in a patient undergoing thoracic surgery. We are the first one to summarize the one-lung ventilation strategy for patients with tracheal bronchus. Case Presentation: A 53-year-old man underwent a scheduled thoracoscopic left upper lobectomy. After two unsuccessful attempts to pass the right-sided double-lumen tube through the right mainstem bronchus, fiberoptic bronchoscopy revealed an aberrant tracheal bronchus with an incidence of 0.1%–3%. Finally we used a left-sided DLT to ventilate the right lung. The patient had no airway complications and was discharged 7 days after the operation.Conclusions: This case serves to remind us that preoperative visits must be thorough and careful. Although a computed tomography chest examination was performed before surgery, we just looked at the inspection report and did not look at the images. We also reviewed relevant literature and summarized the one-lung ventilation strategies for patients with tracheal bronchus. For left-lung ventilation, either a left-sided double-lumen tube or a combination of a bronchial blocker and Fogarty artery embolization catheter can be used. For right-lung ventilation, a bronchial blocker or a left-sided double-lumen tube is a good choice.

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Challenging Lung Isolation Secondary to Aberrant Tracheobronchial Anatomy

Cited by 26 publications

References 14 publications

Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-

Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients -A report of three cases-

The implications of a tracheal bronchus on one-lung ventilation and fibreoptic bronchoscopy in a patient undergoing thoracic surgery: a case report

Difficulty Intubating a Double-Lumen Tube due to a Tracheal Bronchus: A Case Report

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