Case 5
History:
26 year old female with shortness of breath.
Findings:
Axial and coronal reformat of the chest in lung windows showing a small supernumerary right sided bronchus arising from the upper trachea.
Diagnosis:
Supernumerary (accessory or tracheal) bronchus
Discussion:
Supernumerary (accessory) bronchus arising from the lateral wall of the trachea. Most commonly seen as displaced apical segmental bronchus, but it may be a supernumerary apical segmental bronchus, a displaced upper lobe bronchus or more rarely, a supernumerary upper lobe bronchus. Can arise anywhere between the carina and cricoid cartilage, but is most frequently seen within 2 cm of the carina. More common on the right side. The incidence is approximately 0.5-3.0%. May occur in association with other congenital anomalies such as tracheoesophageal fistula, tracheal stenosis and Down’s syndrome. Endotracheal intubation in a patient with a tracheal bronchus can cause obstruction of the tracheal bronchus leading to shunting and hypoxemia.
References:
- Ikeno S, Mitsuhata H, Saito K, et al. Airway management for patients with a tracheal bronchus. Br J Anaesth 1996; 76: 573–5.
- O'Sullivan BP, Frassica JJ, Rayder SM. Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest 1998; 113: 537–40.
- Pribble CG, Dean JM. An unusual cause of intraoperative hypoxemia. J Clin Anesth 1994; 6: 247–9.
- Vredevoe LA, Brechner T, Moy TP. Obstruction of anomalous tracheal bronchus with endotracheal intubation. Anesthesiology 1981; 55: 581–
