Congenital tracheal bronchus: the inability to isolate the right lung with a univent bronchial blocker tube

Implications of endotracheal tube placement in a patient with a true tracheal bronchus

We report a rare anatomic abnormality, a true tracheal bronchus, where the right upper bronchus originates directly from the supracarinal trachea. This unusual anatomic variant can be problematic for the anesthesiologist if it is unrecognized. It can lead to hypoventilation of the right upper bronchus or cause confusion in placement of a double-lumen endotracheal tube if the carina is misidentified, as demonstrated in our case report. Successful isolation of the right lung requires understanding and rapid recognition of the anomaly.

Tracheal bronchus: A rare unforeseen anaesthetic challenge

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.

Tracheal Bronchus: High Resolution Computed Tomography diagnosis in a symptomatic patient

A 75-year-old female underwent a High Resolution Computed Tomography (HRCT) scan for recurrent bronchitis and cough. HRCT images showed an anomalous supernumerary bronchus to the right upper lobe directly arising from the right side of distal trachea, corresponding to Tracheal Bronchus (TrB). TrB can cause recurrent right upper lobe pneumonia and special care is requiring during endotracheal intubation.

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

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.

Anesthesia for tracheal and endobronchial interventions

Tracheal and endobronchial interventions constitute a wide variety of procedures offering unique challenges in perioperative airway management and ventilatory support. Elective or emergent anesthetic management is individualized according to underlying airway pathology, coexisting disease, and patient age. This review explores recent literature and reports on relevant advances in anesthetic care.