TEXT
A 16-year-old boy underwent a chest CT-scan three weeks after the onset of a spontaneous idiopathic pneumomediastinum. The CT-scan revealed a complete resolution of the pneumomediastinum and a tracheal bronchus arising from the right side of the trachea 3 cm above the carina, leading to the apical segment of the right upper lobe (Fig. 1a and b). This incidental finding was not noticed on the initial CT-scan.
Figure 1.
(a) CT-scan transversal view; Tracheal bronchus arising from the right side of the trachea. (b) CT-scan front view; Tracheal bronchus arising from the right side of the trachea and leading to the apical segment of the right upper lobe.
Tracheal bronchus is a rare anatomical variant occurring in 0.06% in an adult population [1]. It originates most frequently from the right tracheal wall and aerates either the entire right upper lobe as a “true tracheal bronchus” or any of its segments, and most commonly the apical as an “apical tracheal bronchus” [2, 3] as was the case in our patient.
Tracheal bronchi are usually asymptomatic and incidentally found during bronchoscopy or CT-scan. Asymptomatic patients do not require any medical intervention. However, tracheobronchial variants have clinical implication during endotracheal intubation. The tracheal bronchus occlusion by an endotracheal tube can lead to atelectasis, post-obstructive pneumonia, or even respiratory failure. Accidental selective intubation of the tracheal bronchus can cause pneumothorax and inadequate ventilation of the remaining lung [3, 4]. Patients with tracheal bronchus should inform the anesthesiologist before any surgical intervention to prevent these complications.
In rare cases of recurrent pneumonia complicated by bronchiectasis and respiratory distress, the surgical resection of the anomalous lobe or segment can be required [3].
ACKNOWLEDGEMENTS
The authors declare no relevant acknowledgements.
Contributor Information
Clément Dhainaut, Department of Thoracic Surgery, Valenciennes Hospital, Valenciennes, France.
François Montagne, Department of Thoracic Surgery, Valenciennes Hospital, Valenciennes, France.
Lotfi Benhamed, Department of Thoracic Surgery, Valenciennes Hospital, Valenciennes, France.
CONFLICT OF INTEREST STATEMENT
There is no conflict of interest.
FUNDING
There was no funding for this publication.
ETHICAL APPROVAL
No ethical approval was needed for this clinical image.
CONSENT
The authors obtained written informed consent from the patient’s father for this publication.
GUARANTOR
Clément Dhainaut is the guarantor of this article.
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