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Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 132-133

What is the airway abnormality?


Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Yenopoya Medical College, Mangalore, Karnataka, India

Date of Submission29-Nov-2021
Date of Acceptance19-Feb-2022
Date of Web Publication12-May-2022

Correspondence Address:
M Vishnu Sharma
Department of Respiratory Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_46_21

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How to cite this article:
Sharma M V, Sohail Mohammed M B, Baig U. What is the airway abnormality?. J Assoc Pulmonologist Tamilnadu 2021;4:132-3

How to cite this URL:
Sharma M V, Sohail Mohammed M B, Baig U. What is the airway abnormality?. J Assoc Pulmonologist Tamilnadu [serial online] 2021 [cited 2022 May 16];4:132-3. Available from: http://www.japt.com/text.asp?2021/4/3/132/345084




  Question Top


This is the computed tomography (CT) scan of a patient who was admitted with left-sided chest pain and cough for the past 6 weeks. What is the airway abnormality? [Figure 1], [Figure 2], [Figure 3].
Figure 1: Tracheal bronchus

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Figure 2: Carina

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Figure 3: Right and left main bronchus

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  Answer Top


Careful comparison of the three images shows right-sided tracheal bronchus. In addition, there was a large intrathoracic mass which was confirmed as non-Hodgkin's lymphoma on biopsy.

When a bronchus originates directly from the trachea before the tracheal bifurcation, it is known as tracheal bronchus. Usually, the origin is within 2–6 cm above the carina. Tracheal bronchus is more common on the right side.[1] The prevalence is 0.1%–2% in various studies.[1],[2]

When a tracheal bronchus is associated with normal branching pattern in the upper lobe, it is called supernumerary tracheal bronchus.[1] If a tracheal bronchus is associated with missing of upper lobe bronchial division, it is known as displaced tracheal bronchus. Displaced tracheal bronchus is more common than supernumerary tracheal bronchus.[3]

Tracheal bronchus can be identified during bronchoscopy and high-resolution spiral CT scan of the chest. CT scan is superior to bronchoscopy as it can delineate the entire anatomy, relation to other intrathoracic structures and other associated anatomical abnormalities if any.[1]

Tracheal bronchus may be associated with other congenital anomalies such as hypoplastic lung, congenital heart disease, chromosomal abnormality, and spinal fusion defects.[4] Majority of tracheal bronchus are asymptomatic. It can predispose to recurrent infection, pneumonia, bronchiectasis, hemoptysis, and malignancy.[1] During intubation, misplacement of endotracheal tube to the tracheal bronchus may lead to serious hypoxia and barotrauma if not recognized and corrected promptly.[5]

Asymptomatic tracheal bronchus does not require any treatment. In symptomatic patients, treatment should be directed to the underlying condition. Surgical resection may be required when conservative treatment fails.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghaye B, Szapiro D, Fanchamps JM, Dondelinger RF. Congenital bronchial abnormalities revisited. Radiographics 2001;21:105-19.  Back to cited text no. 1
    
2.
Manjunath M, Vishnu Sharma M, Kollanur J, John PK. A study on anatomical variations in the tracheobronchial division by CT scan. Pulmon 2020;22:224-8.  Back to cited text no. 2
    
3.
Wooten C, Patel S, Cassidy L, Watanabe K, Matusz P, Tubbs RS, et al. Variations of the tracheobronchial tree: Anatomical and clinical significance. Clin Anat 2014;27:1223-33.  Back to cited text no. 3
    
4.
Setty SP, Michaels AJ. Tracheal bronchus: Case presentation, literature review, and discussion. J Trauma 2000;49:943-5.  Back to cited text no. 4
    
5.
Lai KM, Hsieh MH, Lam F, Chen CY, Chen TL, Chang CC. Anesthesia for patients with tracheal bronchus. Asian J Anesthesiol 2017;55:87-8.  Back to cited text no. 5
    
6.
Xu XF, Chen L, Wu WB, Zhu Q. Thoracoscopic right posterior segmentectomy of a patient with anomalous bronchus and pulmonary vein. Ann Thorac Surg 2014;98:e127-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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