Implications of a tracheal bronchus for adult anaesthetic practice

Conacher, I.D.

doi:10.1093/bja/85.2.317

Cited by 67 publications

(89 citation statements)

References 6 publications

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“…6 The tracheal bronchus is most commonly seen as a displaced apical segmental bronchus, but it may be a supernumerary apical segmental bronchus, a displaced upper lobe bronchus or more rarely, a supernumerary upper lobe bronchus. 7 It can arise anywhere between the carina and cricoid cartilage, but is most frequently seen within 2 cm of the carina, 6,8 and has been reported as high as 6 cm above the carina. 1,[8][9][10] It is much more common on the right side than the left.…”

Section: Discussionmentioning

confidence: 99%

“…7 It can arise anywhere between the carina and cricoid cartilage, but is most frequently seen within 2 cm of the carina, 6,8 and has been reported as high as 6 cm above the carina. 1,[8][9][10] It is much more common on the right side than the left. 6,7 The incidence of tracheal bronchus is reported to be approximately 0.5-3.0%.…”

Section: Discussionmentioning

confidence: 99%

“…7,11,12 Several variants of tracheal bronchus are depicted in Figure 3. 8 A tracheal bronchus involving the upper lobe bronchus has more important anesthetic implications than involvement of the segmental bronchus, as obstruction by an ETT or double-lumen tube would result in a larger area of atelectasis and shunting. 6,8,11 A tracheal bronchus also may occur in association with other congenital anomalies such as tracheoesophageal fistula, tracheal stenosis and Down's syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…8 A tracheal bronchus involving the upper lobe bronchus has more important anesthetic implications than involvement of the segmental bronchus, as obstruction by an ETT or double-lumen tube would result in a larger area of atelectasis and shunting. 6,8,11 A tracheal bronchus also may occur in association with other congenital anomalies such as tracheoesophageal fistula, tracheal stenosis and Down's syndrome. [10][11][12][13][14][15] Recognition of a tracheal bronchus before induction of anesthesia can be helpful for determining optimal positioning of the ETT.…”

Section: Discussionmentioning

confidence: 99%

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

Wong

Kumar

2006

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Wong

Kumar

2006

Can J Anesth/J Can Anesth

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“…For instance, if the bronchial blocker balloon were placed just distal to the tracheal bronchus take-off and inflated, it would have led to obstruction of the left lung as well as the right middle and lower lobes with resulting atelectasis, hypoxemia, and high airway pressures. 3,6 There are various classifications of tracheal bronchus, but a simple classification was described by Conacher et al 3 According to this classification, our case was a type I tracheal bronchus, which is defined as a tracheal bronchus originating C 2 cm above the carina with distal tracheal narrowing. Compared with other types of tracheal bronchus, it is particularly difficult to achieve OLV in patients with a type I tracheal bronchus 3,6 as the bifurcation site is easily confused with the normal tracheobronchial carinal anatomy.…”

Section: Discussionmentioning

confidence: 93%

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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Spanish multicentre study on morbidity and pathogenicity of tracheal bronchus in children

Moreno

Castillo‐Corullón

Pérez-Ruíz³

et al. 2019

Pediatric Pulmonology

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Tracheal bronchus (TRB) has been generally considered an anatomical variant of the tracheobronchial tree without a precise pathological effect. Its prevalence is estimated to be between 0.2% to 3% of all children undergoing bronchoscopy and scientific information has been limited to case reports or small case series. Our working hypothesis was that TRB could trigger by itself recurrent or persistent respiratory symptoms. The objective of this retrospective and multicentre study of children with a diagnosis of TRB, coming from the main paediatric pulmonology units of Spain, was to determine the anatomical and clinical characteristics, including comorbidities, of TRB in childhood and their impact in the patients' clinical outcomes. One hundred thirty‐three patients from 13 institutions were included in the study. Mean diagnostic age was 3.4 years and flexible bronchoscopy was the initial diagnostic method in 85% of cases. All TRB were located on the right wall of the trachea: 76% in the lower third and 24% in the carina. The most common clinical manifestations were obstructive bronchitis (53.3%) and recurrent pneumonia (46.6%), usually affecting the right upper lobe. Regarding associated anomalies, 33% had tracheomalacia, 32% congenital cardiovascular malformations, 28% gastroesophageal reflux, 22.5% congenital tracheal stenosis, and 8.3% Down syndrome. This series appears to be the most extensive published to date addressing this topic and, according to our data, TRB does not appear to be a mere incidental finding but is more likely linked to a wide range of congenital anomalies and contributes by itself to the recurrent respiratory symptomatology that these children exhibit.

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Implications of a tracheal bronchus for adult anaesthetic practice

Cited by 67 publications

References 6 publications

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

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

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

Spanish multicentre study on morbidity and pathogenicity of tracheal bronchus in children

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