Journal of Anesthesia

, Volume 23, Issue 2, pp 260–265 | Cite as

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

  • Tatsushige Iwamoto
  • Yoshihiro Takasugi
  • Kenji Hiramatsu
  • Yoshihisa Koga
  • Tatsuo Konishi
  • Kensuke Kozuka
  • Takamichi Murakami
Clinical Report


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 (\( Sp_{O_2 } \)) 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.

Key words

Tracheal bronchus Three-dimensional computed tomography One-lung ventilation Tracheal stenosis Congenital heart disease 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Doolittle AM, Mair EA. Tracheal bronchus: classification, endoscopic analysis, and airway management. Otolaryngol Head Neck Surg. 2002;126:240–243.PubMedCrossRefGoogle Scholar
  2. 2.
    Ghaye B, Szapiro D, Fanchamps JM, Dondelinger RF. Congenital bronchial abnormalities revisited. Radiographics. 2001;21:105–119.PubMedGoogle Scholar
  3. 3.
    Pribble CG, Dean JM. An unusual cause of intraoperative hypoxemia. J Clin Anesth. 1994;6:247–249.PubMedCrossRefGoogle Scholar
  4. 4.
    Vredevoe LA, Brechner T, Moy P. Obstruction of anomalous tracheal bronchus with endotracheal intubation. Anesthesiology. 1981;55:581–583.PubMedCrossRefGoogle Scholar
  5. 5.
    Peragallo RA, Swenson JD. Congenital tracheal bronchus: the inability to isolate the right lung with a univent bronchial blocker tube. Anesth Analg. 2000;91:300–301.PubMedCrossRefGoogle Scholar
  6. 6.
    Brodsky JB, Mark JB. Bilateral upper lobe obstruction from a single double-lumen tube. Anesthesiology. 1991;74:1163–1164.PubMedCrossRefGoogle Scholar
  7. 7.
    Conacher ID. Implications of a tracheal bronchus for adult anaesthetic practice. Br J Anaesth. 2000;85:317–320.PubMedCrossRefGoogle Scholar
  8. 8.
    Huntington GS. Critique of theories of pulmonary evolution in mammalia. Am J Anat. 1920;27:99–201.CrossRefGoogle Scholar
  9. 9.
    Chen SJ, Lee WJ, Wang JK, Wu MH, Chang CI, Liu KL, Chiu IS, Chen HY, Su CT, Li YW. Usefulness of three-dimensional electron beam computed tomography for evaluating tracheobronchial anomalies in children with congenital heart disease. Am J Cardiol. 2003;92:483–486PubMedCrossRefGoogle Scholar
  10. 10.
    Ming Z, Lin Z. Evaluation of tracheal bronchus in Chinese children using multidetector CT. Pediatr Radiol. 2007;37:1230–1234.PubMedCrossRefGoogle Scholar
  11. 11.
    Kairamkonda V, Thorburn K, Sarginson R. Tracheal bronchus associated with VACTERL. Eur J Pediatr. 2003;162:165–167.PubMedGoogle Scholar
  12. 12.
    Fowler CL, Pokorny WJ, Wagner ML, Kessler MS. Review of bronchopulmonary foregut malformations. J Pediatr Surg. 1988;23:793–797.PubMedCrossRefGoogle Scholar
  13. 13.
    Donnelly LF, Strife JL, Bailey WW. Extrinsic airway compression secondary to pulmonary arterial conduits: MR findings. Pediatr Radiol. 1997;27:268–270.PubMedCrossRefGoogle Scholar
  14. 14.
    Dailey ME, O’Laughlin MP, Smith RJ. Airway compression secondary to left atrial enlargement and increased pulmonary artery pressure. Int J Pediatr Otorhinolaryngol. 1990;19:33–44.PubMedCrossRefGoogle Scholar
  15. 15.
    Wong DT, Kumar A. Case report: endotracheal tube malposition in a patient with a tracheal bronchus. Can J Anaesth. 2006;53:810–813.PubMedCrossRefGoogle Scholar
  16. 16.
    Siegel MJ, Shackelford GD, Francis RS, McAlister WH. Tracheal bronchus. Radiology. 1979;130:353–355.PubMedGoogle Scholar
  17. 17.
    Gerson CE, Rothstein E. An anomalous tracheal bronchus to the right upper lobe. Am Rev Tuberc. 1951;64:686–690.PubMedGoogle Scholar
  18. 18.
    Inada T, Uesugi F, Kawachi S, Takubo K. Changes in tracheal tube position during laparoscopic cholecystectomy. Anaesthesia. 1996;51:823–826.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee HL, Ho AC, Cheng RK, Shyr MH. Successful one-lung ventilation in a patient with aberrant tracheal bronchus. Anesth Analg. 2002;95:492–493.PubMedCrossRefGoogle Scholar
  20. 20.
    Middleton RM, Littleton JT, Brickey DA, Picone AL. Obstructed tracheal bronchus as a cause of post-obstructive pneumonia. J Thorac Imaging. 1995;10:223–224.PubMedCrossRefGoogle Scholar
  21. 21.
    O’sullivan BP, Frassica JJ, Rayder SM. Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest. 1998;113:537–540.PubMedCrossRefGoogle Scholar
  22. 22.
    Ikeno S, Mitsuhata H, Saito K, Hirabayashi Y, Akazawa S, Kasuda H, Shimizu R. Airway management for patients with a tracheal bronchus. Br J Anaesth. 1996;76:573–575.PubMedGoogle Scholar
  23. 23.
    Newell JD, Thomas HM, Maurer JW. Computed tomographic demonstration of displaced right upper lobe bronchus in an adult woman with congenital heart disease. J Comput Tomogr. 1984;8:75–79.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Tatsushige Iwamoto
    • 1
  • Yoshihiro Takasugi
    • 1
  • Kenji Hiramatsu
    • 1
  • Yoshihisa Koga
    • 1
  • Tatsuo Konishi
    • 3
  • Kensuke Kozuka
    • 2
  • Takamichi Murakami
    • 2
  1. 1.Department of AnesthesiologyKinki University School of MedicineOsaka-sayamaJapan
  2. 2.Department of RadiologyKinki University School of MedicineOsakaJapan
  3. 3.Department of RadiologyKinki University HospitalOsakaJapan

Personalised recommendations