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Yamamoto T, Tsurumaki T, Kanemaru H, Seo K. Tracheal Bronchus Detected During General Anesthesia: A Case Report. Anesth Prog 2023; 70:173-177. [PMID: 38221699 PMCID: PMC11088200 DOI: 10.2344/anpr-70-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/14/2023] [Indexed: 01/16/2024] Open
Abstract
A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skin grafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentally observed at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not used in many anesthesia cases, making the identification of such tracheal or bronchial abnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without neglecting routine safety checks.
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Affiliation(s)
- Toru Yamamoto
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Tatsuru Tsurumaki
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroko Kanemaru
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Kenji Seo
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
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2
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Khan D, Sengupta S, Mukhopadhyay S, Pati G. Rare case of tracheal bronchus in a patient posted for minimal invasive cardiac surgery. Ann Card Anaesth 2020; 23:364-366. [PMID: 32687102 PMCID: PMC7559964 DOI: 10.4103/aca.aca_215_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The tracheal bronchus is a rare congenital anomaly which occurs as a result of an additional tracheal outgrowth early in the embryonic life. It originates more commonly from the right wall of the trachea, above the carina. It is usually asymptomatic but may cause recurrent pneumonia, chronic bronchitis, or bronchiectasis. Here, we present the case of a 57-year-old lady posted for minimally invasive coronary surgery who was incidentally found to have an accessory bronchus during establishing one lung ventilation. The clinical implications of such a scenario is highlighted.
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Affiliation(s)
- Dibyendu Khan
- Department of Anesthesiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Saikat Sengupta
- Department of Anesthesiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Sushan Mukhopadhyay
- Department of Cardiothoracic Surgery, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Gautam Pati
- Department of Anesthesiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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3
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Critchley LAH, Ho AMH, Ho M, Lee SY. Right Upper Lobe Collapse Secondary to an Anomalous Bronchus after Endotracheal Intubation for Routine Surgery. Anaesth Intensive Care 2019; 35:274-7. [PMID: 17444320 DOI: 10.1177/0310057x0703500219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perioperative hypoxaemia is a common but serious problem with well recognised causes. However, an anomalous bronchus causing lobar collapse as a cause is seldom mentioned. A healthy young male patient was anaesthetised for a knee operation. He required reintubation immediately postoperatively for hypoxia. He was found to have right upper lobe collapse. Fibreoptic examination of the trachea demonstrated an anomalous bronchus as the cause. Intra-operatively, the endotracheal tube had been inserted too deeply and the bronchial orifice had been obstructed by the tip. It took several hours for the lung to re-expand. Greater awareness of this potential complication is needed.
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Affiliation(s)
- L A H Critchley
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Ho AK, Ho AMH, Mizubuti GB. Blockage of the tracheal bronchus: effects on blood oxygen content, partial pressure of oxygen, and intrapulmonary shunt. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:383-386. [PMID: 29761713 DOI: 10.1152/advan.00017.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Adrienne K Ho
- Department of Oncology, The Christie NHS Foundation Trust , Manchester , United Kingdom
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University , Kingston, Ontario , Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University , Kingston, Ontario , Canada
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Sarkar ME, Inbaraj A, Zachariah V, Shukla S. Tracheal bronchus: A rare unforeseen anaesthetic challenge. Indian J Anaesth 2018; 62:621-624. [PMID: 30166658 PMCID: PMC6100277 DOI: 10.4103/ija.ija_180_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most common congenital central airway anomaly, a tracheal bronchus is of concern during airway management especially if previously undetected. If present, it can lead to inadequate ventilation both during intubation with a normal endotracheal tube and an attempted double lumen tube insertion for one lung ventilation. Meticulous preoperative assessment and use of adjuncts like bronchoscopy before lung isolation can safely and successfully assist the anaesthetic management of such cases.
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Affiliation(s)
- Mita Eunice Sarkar
- Department of Anaesthesiology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Alfred Inbaraj
- Department of Radiology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Varghese Zachariah
- Department of Anaesthesiology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Sharmishta Shukla
- Department of Anaesthesiology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
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6
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Ruzycki S, Tsai WH, Davidson WJ. Flow-volume loop abnormality detecting a previously unrecognized right upper lobe tracheal bronchus. Respir Med Case Rep 2015; 15:1-3. [PMID: 26236587 PMCID: PMC4501453 DOI: 10.1016/j.rmcr.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tracheal bronchus is a rare anatomic variant in which a bronchus originates from the trachea. Patients may be asymptomatic or present with a variety of respiratory symptoms. We present a case of a patient who presented with a history of poorly controlled asthma and a persistent abnormality of the flow-volume loop. Bronchoscopy revealed a tracheal bronchus with narrowed right-sided bronchial orifices. An unrecognized tracheal bronchus may result in serious complications during elective or emergent endotracheal intubation. Spirometry testing may reveal abnormalities of the flow-volume loop associated with altered airflow. Relying on spirometric values without assessing the shape of the flow-volume loop may lead to misdiagnosis and inappropriate management of lung pathology.
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Affiliation(s)
- Shannon Ruzycki
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Willis H. Tsai
- Department of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Warren J. Davidson
- Department of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
- Corresponding author. 7007-14th Street SW, Calgary AB, T2V 1P9, Canada. Tel.: +1 (403) 943 8864; fax: +1 (403) 943 8666.
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7
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[One-lung ventilation in a patient with a tracheal bronchus]. ACTA ACUST UNITED AC 2014; 33:272-4. [PMID: 24685371 DOI: 10.1016/j.annfar.2014.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/11/2014] [Indexed: 11/22/2022]
Abstract
We report a patient in whom a tracheal bronchus was discovered intraoperatively during an endoscopy control. This observation led us to a focus on what to do in such cases.
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Choi YS, Kwak YL, Choi HG, Oh SY, Lee JW. Anesthetic experience of an adult patient with an unrecognized tracheal bronchus -A case report-. Korean J Anesthesiol 2011; 59 Suppl:S13-6. [PMID: 21286422 PMCID: PMC3030018 DOI: 10.4097/kjae.2010.59.s.s13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 04/20/2010] [Accepted: 04/30/2010] [Indexed: 11/25/2022] Open
Abstract
We present a case of problematic tracheal intubation in an adult patient with an unrecognized tracheal bronchus. Immediately after tracheal intubation and position change to prone, bilateral breath sounds were almost absent, and there was a diminished tidal volume. In order to resolve the ventilatory difficulty, the wire-reinforced tube was replaced with a conventional tube, and proper positioning of the tube was completed under fiberoptic guidance. A tracheal bronchus (originating about 1.2 cm above the carina, and supplying the right upper lobe) was found on the postoperative chest CT. In the presence of tracheal bronchus, tracheal intubation may cause pulmonary complications. Anesthesiologists should keep in mind the anesthetic implications of tracheal bronchus, and must be familiar with the use of fiberoptic bronchoscopy for proper positioning of endotracheal tube.
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Affiliation(s)
- Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yonsei University, Seoul, Korea
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Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation. J Anesth 2009; 23:260-5. [DOI: 10.1007/s00540-008-0716-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 11/06/2008] [Indexed: 10/20/2022]
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Sripada R, Keys K, Eichholz KM. Inability to ventilate the lungs of a patient with tracheal anomaly and in prone position. J Clin Anesth 2009; 20:386-388. [PMID: 18761251 DOI: 10.1016/j.jclinane.2008.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 02/20/2008] [Accepted: 03/09/2008] [Indexed: 10/21/2022]
Abstract
We present the case of an otherwise asymptomatic patient with a rare congenital airway abnormality of the tracheobronchial tree, who developed a complete airway obstruction after being placed in the prone position. The tracheal bronchus, accessory bronchus arising from the trachea superior to its bifurcation at the carina, was identified by fiberoptic bronchoscopic examination. An endotracheal tube can migrate into a tracheal bronchus causing pulmonary atelectasis, hypoxia, or both.
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Affiliation(s)
- Ramprasad Sripada
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232-8510, USA.
| | - Kristal Keys
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232-8510, USA
| | - Kurt M Eichholz
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-8510, USA
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Wong DT, Kumar A. Case report: Endotracheal tube malposition in a patient with a tracheal bronchus. Can J Anaesth 2006; 53:810-3. [PMID: 16873348 DOI: 10.1007/bf03022798] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE A tracheal bronchus is a congenital abnormality of the tracheobronchial tree, in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We report a patient with a tracheal bronchus that was found incidentally during surgery in the prone position, and the potential airway management problems which may have ensued. CLINICAL FEATURES A 70-yr-old female underwent posterior spinal decompression and fusion in the prone position. Intraoperatively, end-tidal CO2 and airway pressure increased. Fibreoptic bronchoscopy revealed that the endotracheal tube (ETT) was kinked at the 16 cm mark, which was corrected by rotating the patient's head and ETT. When the bronchoscope was advanced beyond the tip of the ETT, a tracheal-bronchial tree trifurcation was identified. Endobronchial intubation was suspected. As the ETT was withdrawn, the endoluminal view remained unchanged. During bronchoscopy, the patient's trachea was nearly extubated in the prone position. Subsequent bronchoscopy of the major bronchial divisions showed that the trifurcation represented left main stem bronchus, bronchus intermedius and right upper lobe bronchus. Once the tracheal bronchus was recognized, the tip of the ETT was repositioned 3 cm above the tracheal trifurcation, and the rest of the case was uneventful. CONCLUSION This case highlights the diagnostic challenge and airway management implications of one variant of a tracheal bronchus when airway problems are encountered intraoperatively. This knowledge should be applied in the differential diagnosis and management of intraoperative hypoxemia; and in the proper positioning of the ETT.
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Affiliation(s)
- David T Wong
- Department of Anesthesiology, MC 2-405, Toronto Western Hospital, University of Toronto, Ontario M5T 2S8, Canada.
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Yildiz H, Ugurel S, Soylu K, Tasar M, Somuncu I. Accessory cardiac bronchus and tracheal bronchus anomalies: CT-bronchoscopy and CT-bronchography findings. Surg Radiol Anat 2006; 28:646-9. [PMID: 17122903 DOI: 10.1007/s00276-006-0147-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 08/04/2006] [Indexed: 11/25/2022]
Abstract
Most common developmental anomalies of bronchial tree include accessory cardiac bronchus (ACB) and tracheal bronchus (TB). Minor bronchial anomalies include variants of TB, displaced segmental bronchi, and bronchial agenesis. We present CT-bronchoscopy and CT-bronchography findings of three cases with either ACB or TB. Recognition of these anomalies is important, as associated clinical complications, including recurrent episodes of infection, hemoptysis, and perhaps malignancies may be anticipated in a small percentage of patients.
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Affiliation(s)
- Harun Yildiz
- Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey.
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Skouteris CA, Mylonas AI, Galanaki EJ, Angelopoulos AP. Acute bronchial obstruction after nasotracheal intubation: Report of a case. J Oral Maxillofac Surg 2002; 60:1188-92. [PMID: 12378497 DOI: 10.1053/joms.2002.35031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chris A Skouteris
- Oral and Maxillofacial Surgery, Evangelismos General Hospital of Athens, Greece.
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Massoni C, Gimbert A, Escande G, Bazin JE. [A rare cause of accidental selective intubation: right upper lobar bronchus originating from the trachea]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 16:187-9. [PMID: 9686078 DOI: 10.1016/s0750-7658(97)87198-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A case of accidental selective intubation of a right upper lobar bronchus originating from the trachea, in a woman with a normal preoperative chest X-ray, is reported. The preoperative diagnosis of an asymptomatic tracheal bronchus is often difficult on a standard chest X-ray, especially since a chest X-ray is no longer systematically included in the preanaesthetic assessment. Therefore, the presence of a bronchial malformation should be considered as a cause of ventilatory problems, particularly those occurring after tracheal intubation.
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Affiliation(s)
- C Massoni
- Département d'anesthésie-réanimation, hôpital Gabriel-Montpied, Clermont-Ferrand, France
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Fourier C, Cremer R, Leteurtre S, Martinot A, Boussard L, Marquette CH, Declerck N, Pruvot FR, Leclerc F. Hypoxemia due to the obstruction of a right tracheal bronchus by an endotracheal tube in a child with left bronchial foreign body aspiration. Pediatr Pulmonol 1998; 25:343-4. [PMID: 9635937 DOI: 10.1002/(sici)1099-0496(199805)25:5<343::aid-ppul9>3.0.co;2-j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C Fourier
- Department of Pulmonology, University Hospital of Lille, France
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Gómez-Pastrana Durán D, Sánchez Durán M, Andrés Martín A. [Tracheal bronchiole]. Arch Bronconeumol 1996; 32:433. [PMID: 8983577 DOI: 10.1016/s0300-2896(15)30733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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