Skip to main content

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

Journal of Anesthesia volume 23, pages 260–265 (2009)Cite this article

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 (\( Sp_{O_2 } \)) 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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Doolittle AM, Mair EA. Tracheal bronchus: classification, endoscopic analysis, and airway management. Otolaryngol Head Neck Surg. 2002;126:240–243.

    PubMed  Article  Google Scholar 

  2. Ghaye B, Szapiro D, Fanchamps JM, Dondelinger RF. Congenital bronchial abnormalities revisited. Radiographics. 2001;21:105–119.

    PubMed  CAS  Google Scholar 

  3. Pribble CG, Dean JM. An unusual cause of intraoperative hypoxemia. J Clin Anesth. 1994;6:247–249.

    PubMed  Article  CAS  Google Scholar 

  4. Vredevoe LA, Brechner T, Moy P. Obstruction of anomalous tracheal bronchus with endotracheal intubation. Anesthesiology. 1981;55:581–583.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  6. Brodsky JB, Mark JB. Bilateral upper lobe obstruction from a single double-lumen tube. Anesthesiology. 1991;74:1163–1164.

    PubMed  Article  CAS  Google Scholar 

  7. Conacher ID. Implications of a tracheal bronchus for adult anaesthetic practice. Br J Anaesth. 2000;85:317–320.

    PubMed  Article  CAS  Google Scholar 

  8. Huntington GS. Critique of theories of pulmonary evolution in mammalia. Am J Anat. 1920;27:99–201.

    Article  Google Scholar 

  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;92:483–486

    PubMed  Article  Google Scholar 

  10. Ming Z, Lin Z. Evaluation of tracheal bronchus in Chinese children using multidetector CT. Pediatr Radiol. 2007;37:1230–1234.

    PubMed  Article  Google Scholar 

  11. Kairamkonda V, Thorburn K, Sarginson R. Tracheal bronchus associated with VACTERL. Eur J Pediatr. 2003;162:165–167.

    PubMed  Google Scholar 

  12. Fowler CL, Pokorny WJ, Wagner ML, Kessler MS. Review of bronchopulmonary foregut malformations. J Pediatr Surg. 1988;23:793–797.

    PubMed  Article  CAS  Google Scholar 

  13. Donnelly LF, Strife JL, Bailey WW. Extrinsic airway compression secondary to pulmonary arterial conduits: MR findings. Pediatr Radiol. 1997;27:268–270.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  15. Wong DT, Kumar A. Case report: endotracheal tube malposition in a patient with a tracheal bronchus. Can J Anaesth. 2006;53:810–813.

    PubMed  Article  Google Scholar 

  16. Siegel MJ, Shackelford GD, Francis RS, McAlister WH. Tracheal bronchus. Radiology. 1979;130:353–355.

    PubMed  CAS  Google Scholar 

  17. Gerson CE, Rothstein E. An anomalous tracheal bronchus to the right upper lobe. Am Rev Tuberc. 1951;64:686–690.

    PubMed  CAS  Google Scholar 

  18. Inada T, Uesugi F, Kawachi S, Takubo K. Changes in tracheal tube position during laparoscopic cholecystectomy. Anaesthesia. 1996;51:823–826.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  21. O’sullivan BP, Frassica JJ, Rayder SM. Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest. 1998;113:537–540.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Anesthesiology, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-sayama, 589-8511, Japan

    Tatsushige Iwamoto, Yoshihiro Takasugi, Kenji Hiramatsu & Yoshihisa Koga

  2. Department of Radiology, Kinki University School of Medicine, Osaka, Japan

    Kensuke Kozuka & Takamichi Murakami

  3. Department of Radiology, Kinki University Hospital, Osaka, Japan

    Tatsuo Konishi

Authors
  1. Tatsushige Iwamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihiro Takasugi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenji Hiramatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshihisa Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatsuo Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kensuke Kozuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takamichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Iwamoto, T., Takasugi, Y., Hiramatsu, K. et al. Three-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation. J Anesth 23, 260–265 (2009). https://doi.org/10.1007/s00540-008-0716-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-008-0716-1

Key words

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