Difficulty in placement of a left-sided double-lumen tube due to aberrant tracheobronchial anatomy

Yoshimura, Tatsuya; Ueda, Kenichi; Kakinuma, Akihito; Nakata, Yoshinori

doi:10.1016/j.jclinane.2013.01.018

Cited by 21 publications

(17 citation statements)

References 7 publications

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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: 71%

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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Section: Discussionmentioning

confidence: 71%

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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“…There have been reports of TB in the past, but for the treatment of such patients during double-lumen endotracheal intubation, only Yoshimura [14] has described the strategy of right lung isolation. We have evaluated more cases and summarized the isolation strategies of the left and right lungs respectively, which has never been previously reported.…”

Section: Discussionmentioning

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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“…The Conacher classification system describes TrB based on the potential challenges to intubation. 1 In this widely used system, Type 1 TrB originate at the mid-tracheal level and are accompanied by distal tracheal narrowing, 1 , 3 , 9 while Type 3 TrB, which are also known as carina trifurcations, arise from the carina. 1 , 8 The level of origin of a Type 2 TrB, characterized by a distal trachea of normal diameter, has been reported as being from 1 cm above the carina to as much as 6 cm from the carina.…”

Section: Discussionmentioning

confidence: 99%

Use of the Human Broncho® Double-Lumen Tube in a Tracheal Bronchus Patient After Failed Lung Isolation with a Broncho-Cath™: A Case Report

Byun¹,

Kim²

2021

IMCRJ

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Airway management for one-lung ventilation may be challenging for anesthesiologists depending on the location of the tracheal bronchus orifice and possible anatomical distortions. Polyvinyl chloride double-lumen tube Broncho-Cath™ has been successfully used for one-lung ventilation in most cases of tracheal bronchus arising within 2 cm above the carina. However, there have been reports of occasional failure. A 78-year-old male patient diagnosed with secondary pneumothorax was scheduled for video-assisted thoracic surgery, and the tracheal bronchus originating 1.9 cm above the carina was shown in the preoperative chest computed tomography. Although a left-sided Broncho-Cath was initially placed, one-lung ventilation could not be achieved. Under bronchoscopy view through the tracheal lumen, the tracheal bronchus orifice was found to be partially obstructed. Furthermore, the bronchial cuff was herniated from the left main bronchus, leading to a failure of one-lung ventilation. The Broncho-Cath was replaced with a silicone double-lumen tube Human Broncho ® , which has more flexible bronchial segment and an increased marginal gap between the bronchial cuff and the tracheal lumen opening. The Human Broncho was successfully placed in an optimal position within the left main bronchus without blocking the tracheal bronchus orifice, thereby achieving the successful one-lung ventilation. The structurally unique Human Broncho may be considered as an alternative option in thoracic surgery of tracheal bronchus patients if lung isolation cannot be achieved with the Broncho-Cath.

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Difficulty in placement of a left-sided double-lumen tube due to aberrant tracheobronchial anatomy

Cited by 21 publications

References 7 publications

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

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

Use of the Human Broncho® Double-Lumen Tube in a Tracheal Bronchus Patient After Failed Lung Isolation with a Broncho-Cath™: A Case Report

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