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

Abstract

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.

Keywords: Bronchial blocker; Double lumen tube; One lung ventilation; Tracheal bronchus.

Fig. 1

(A) Coronal CT imaging demonstrates a tracheal bronchus (arrow) approximately 1 cm proximal to the carina. (B) Fiberoptic examination of the distal trachea confirms a tracheal bronchus (arrow).

Fig. 2

Displaced (B, C) and supernumerary (E, F) tracheal bronchi. They are determined based on the presence or absence of normal trifurcation of the RUL bronchus [9]. (A) Normal, (B) Displaced apical bronchus, (C) Displaced lobar bronchus, (D) Aberrant lobar bronchus, (E) Supernumerary apical bronchus, (F) Supernumerary lobar bronchus. Rt. br: right main stem bronchus, Lt. br: left main bronchus, Ant: anterior segment, Post: posterior segment, Apical: apical segment.