Tracheal bronchus (TB) is a congenital developmental anatomical variation in which a bronchus abnormally originates from the trachea. This paper reports a case of tracheal bronchus in the apical segment of the right upper lung, along with incomplete stenosis and occlusion of the apicoanterior and apicoposterior segments of the right upper lung. The patient was a 62-year-old male who had undergone a left upper lobectomy one year prior. A follow-up chest CT scan revealed a solitary nodule in the right lower lobe, highly suggestive of metastatic carcinoma, as well as postoperative changes in the apicoanterior and apicoposterior segments of the left upper lobe. Additionally, an abnormal bronchial opening on the right side was identified approximately 0.8 cm above the tracheal carina. The patient opted for surgical resection and subsequently underwent a "thoracoscopic right lower lobectomy with lymph node dissection and pleural adhesion cauterization" under "total intravenous anesthesia with tracheal intubation combined with a bronchial blocker and paravertebral nerve block anesthesia." Intraoperatively, fiberoptic bronchoscopy revealed an abnormal bronchial opening in the main trachea, approximately 0.8 cm above the carina, supplying the apical segment of the right upper lung. Narrowed and occluded openings were observed at approximately 0.2 cm and 0.5 cm distal to the right upper lung apical segment bronchial opening, corresponding to the apicoanterior and apicoposterior segments, respectively. This patient was classified as Conacher Type III TB. Since the surgery involved the ipsilateral lower lobe, the degree of lung inflation did not interfere with the surgical procedure, and no special intervention was required. The patient regained spontaneous breathing immediately after surgery and was successfully discharged five days later. TB is a rare condition with an unclear etiology, and Conacher classification provides valuable guidance for anesthesiologists in airway management. Familiarity with the imaging and fiberoptic bronchoscopic characteristics of TB, comprehensive preoperative assessment, timely intraoperative identification of abnormal airways, and early detection and management are crucial in preventing potential surgical complications in TB patients.
Humans ; Male ; Middle Aged ; Bronchi/abnormalities* ; Trachea/abnormalities* ; Lung/surgery* ; Bronchoscopy ; Pneumonectomy

Heterotaxy syndrome (HS) is a congenital disorder resulting from an abnormal arrangement of visceral organs across the normal left-right axis in the embryonic period. HS is usually associated with multiple anomalies, including defects of the major cardiovascular system and the extracardiovascular system such as intestinal malrotation, abnormal lung lobulation, bronchus anomalies, and pancreatic dysplasia. Although pancreatic dysplasia is occasionally accompanied with HS, the occurrence of diabetes mellitus (DM) due to pancreatic dysplasia in HS is rarely reported. We here report a case involving 13-year-old girl with DM caused by agenesis of the dorsal pancreas and HS diagnosed on the basis of the presence of a double-outlet right ventricle with bilateral pulmonary stenosis and intestinal malrotation with duodenal cyst. Timely diagnosis and treatment with insulin improved glycemic control.
Adolescent ; Bronchi ; Cardiovascular System ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Diabetes Mellitus* ; Diagnosis ; Double Outlet Right Ventricle ; Female ; Heterotaxy Syndrome* ; Humans ; Insulin ; Lung ; Pancreas* ; Pulmonary Valve Stenosis

A 42-year-old man was diagnosed with cancer of the right lower lung lobe with a posteparterial type of tracheal bronchus, in which the posterior segmental bronchus of the right upper lobe arose from the distal bronchus intermedius. A mass involved the distal bronchus intermedius, requiring a right lower bilobectomy with an additional posterior segmental resection of the right upper lung lobe. Thus, we performed a right lower bilobectomy and sleeve anastomosis of the posterior segmental bronchus of the right upper lobe to the proximal bronchus intermedius, sparing the pulmonary parenchyma of the same lobe.
Adult ; Bronchi* ; Humans ; Lung Neoplasms* ; Lung* ; Respiratory System Abnormalities ; Trachea

Bronchi ; abnormalities ; Child, Preschool ; Choristoma ; complications ; Esophageal Stenosis ; congenital ; etiology ; Female ; Humans ; Trachea ; abnormalities

Bronchi ; abnormalities ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Multidetector Computed Tomography ; methods ; Pulmonary Artery ; diagnostic imaging ; Trachea ; abnormalities

PURPOSE: Tracheal bronchus is an aberrant bronchus arising from tracheal wall above the carina. Most cases of tracheal bronchus are asymptomatic, so they are diagnosed incidentally. Tracheal bronchus may be associated with other anomalies. The aim of this study is to evaluate the clinical characteristics of tracheal bronchus. METHODS: This study was conducted on 19 children who were diagnosed as tracheal bronchus by the chest computed tomography from January 2000 to December 2011. Based on the medical record, clinical features, such as symptoms, radiologic findings, combined anomalies were evaluated retrospectively. RESULTS: The age at diagnosis was ranged from 2 day to 14 years (mean, 51 months). Among the 19 children, twelve children (63.2%) were boys and seven children (36.8%) were girls. Eighteen children (94.7%) had right-side tracheal bronchus and one child (5.3%) had left-side tracheal bronchus. Displaced type were fourteen children (73.7%), supernumerary type were five children (26.3%). Thirteen children (68.4%) had no respiratory symptoms, but five children (26.3%) had persistent cough and four children (21.1%) had recurrent wheezing. Combined congenital abnormalities were present in seventeen children (89.5%), including congenital cardiovascular anomaly (n=14, 73.7%), trachea-esophageal fistula (n=3, 15.8%), Down syndrome (n=2, 10.5%). CONCLUSION: The patients with tracheal bronchus had not severe respiratory symptoms, but had many combined anomalies. So, it is necessary to consider the presence of tracheal bronchus in children with respiratory symptom, like recurrent wheezing, and to evaluate clinical significance, like combined anomaly, in tracheal bronchus patients. The limitation of this study is that the study group includes many cardiovascular disease patients (84.2%).
Bronchi ; Cardiovascular Diseases ; Child ; Congenital Abnormalities ; Cough ; Down Syndrome ; Fistula ; Humans ; Medical Records ; Respiratory Sounds ; Thorax

Congenital short trachea is a rare congenital anomaly in which the trachea is composed of reduced number of cartilage rings, which result in an abnormally high position of the carina and an abnormal course of the main bronchi. Hazards of congenital short trachea in infants and children include inadvertent bronchial intubation, because it causes bronchiostenosis, pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, and ipsilateral atelectasis. Laryngeal cleft is a rare condition, as well. Symptoms range from mild stridor to massive aspiration and respiratory distress, depending on the severity of the cleft. Until now, a case with combination of these two rare congenital defects has not been reported. Herein, we report a 13 month-old boy who has congenital short trachea with laryngeal cleft.
Bronchi ; Cartilage ; Child ; Congenital Abnormalities ; Emphysema ; Humans ; Infant ; Intubation ; Larynx ; Mediastinal Emphysema ; Pneumothorax ; Pulmonary Atelectasis ; Respiratory Sounds ; Trachea

OBJECTIVETo study the relationship of the incidence of bronchial dysplasia (bronchial anomalous origin and bronchial stenosis) with congenital heart disease.

METHODSA total of 185 children with congenital heart disease or bronchial dysplasia were enrolled. Bronchial dysplasia was identified by the 64-MSCT conventional scanning or thin slice scanning with three-dimensional reconstruction.

RESULTSForty-five children (25.3%) had coexisting bronchial dysplasia and congenital heart disease. The incidence rate of bronchial dysplasia in children with congenital heart disease associated with ventricular septal defect was higher than in those without ventricular septal defect (33.7% vs 15.0%; P<0.05). There were no significant differences in the incidence rate of bronchial dysplasia between the children with congenital heart disease who had a large vascular malformation and who did not.

CONCLUSIONSBronchial dysplasia often occurs in children with congenital heart disease. It is necessary to perform a tracheobronchial CT scanning with three-dimensional reconstruction to identify tracheobronchial dysplasia in children with congenital heart disease, especially associated with ventricular septal defect.

Adolescent ; Bronchi ; abnormalities ; embryology ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Infant ; Male ; Tomography, X-Ray Computed

Tracheomegaly or tracheobronchomegaly is a rare syndrome that consists of marked dilatation of the trachea and the major bronchi, and this is usually due to a congenital defect of the elastic and muscle fibers of the tracheobroncheal tree. Physicians have had only limited experience with performing anesthesia in patients with this type of syndrome. This syndorme is diagnosed by roentenological investigation and this condition is frequently associated with chronic respiratory infection and partial airway obstruction. In this report, we present a case of performing tracheostomy for a patient with tracheomegaly, and this was probably secondary to mechanical ventilator therapy. The regular tracheostomy tube did not provided sufficient length to allow the cuff to lie properly in the trachea in this patient. Because of the peri-cuff air leakgae and hypercapnea after tracheostomy, we needed a longer tracheostomy tube. But we didn't have such a tube and we didn't know any other method, so we couldn't perform tracheostomy. Therefore, we introduced a method of reducing the length of the endotracheal tube to a suitable size until a longer tracheostomy tube can be obtained for those patients having tracheomegaly.
Airway Obstruction ; Anesthesia ; Bronchi ; Congenital Abnormalities ; Dilatation ; Humans ; Muscles ; Trachea ; Tracheobronchomegaly ; Tracheostomy ; Ventilators, Mechanical

Tracheomegaly or tracheobronchomegaly is a rare syndrome that consists of marked dilatation of the trachea and the major bronchi, and this is usually due to a congenital defect of the elastic and muscle fibers of the tracheobroncheal tree. Physicians have had only limited experience with performing anesthesia in patients with this type of syndrome. This syndorme is diagnosed by roentenological investigation and this condition is frequently associated with chronic respiratory infection and partial airway obstruction. In this report, we present a case of performing tracheostomy for a patient with tracheomegaly, and this was probably secondary to mechanical ventilator therapy. The regular tracheostomy tube did not provided sufficient length to allow the cuff to lie properly in the trachea in this patient. Because of the peri-cuff air leakgae and hypercapnea after tracheostomy, we needed a longer tracheostomy tube. But we didn't have such a tube and we didn't know any other method, so we couldn't perform tracheostomy. Therefore, we introduced a method of reducing the length of the endotracheal tube to a suitable size until a longer tracheostomy tube can be obtained for those patients having tracheomegaly.
Airway Obstruction ; Anesthesia ; Bronchi ; Congenital Abnormalities ; Dilatation ; Humans ; Muscles ; Trachea ; Tracheobronchomegaly ; Tracheostomy ; Ventilators, Mechanical