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

Abstract

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.

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

“…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.…”

“…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.…”

“…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. As a result, if the tracheal bronchus is not diagnosed preoperatively, the anesthesiologist may not necessarily suspect a tracheal bronchus even after FOB.…”

“…As a result, if the tracheal bronchus is not diagnosed preoperatively, the anesthesiologist may not necessarily suspect a tracheal bronchus even after FOB. 3,6 Moreover, distal narrowing of the trachea can also limit the methods of OLV. As the main body of a double-lumen endotracheal tube (DLT) has an outer diameter of 12-14 mm, airway trauma could occur with its placement in a narrowed distal trachea.…”

Tracheal Bronchus as an Incidental Finding in Trauma Patient: A Case Report.

“…Patients withtracheal bronchus should be identified and those aware to have this anomaly must inform the anesthesiologist preoperatively for those going forelective surgeryespecially cardiothoracic surgery with single-lung ventilation because serious prolong hypoxia and atelectasis may occur. (11)(12)(13).…”