Tracheobronchial abnormalities are rare congenital anomalies (1). Chest computed tomography (CT) of a 56-year-old woman revealed an accessory cardiac bronchus [red arrows (Picture 1), ray sum (Picture 2), bronchoscopic (Picture 3A), and virtual bronchoscopic images (Picture 3B)] connected to an aerated accessory lobe (yellow region, Picture 1) and separated from other lobes by an interlobar fissure. Bubbles entered and exited the branches of the accessory cardiac bronchus during ventilation, suggesting that the bronchi were connected to the aerated accessory lobe. Accessory cardiac bronchus is a rare supernumerary bronchus arising mostly from the right main or intermediate bronchus. Its prevalence on chest CT has been reported to be 0.2% (2) but may be lower in the general population. In most cases, the bronchus terminates blindly, but 25-33% are associated with a ventilated lobulus, as in our case. Accessory cardiac bronchus is usually asymptomatic, appearing as an incidental finding on chest CT or bronchoscopy. However, it can manifest as recurrent episodes of hemoptysis and infection, especially in cases with long blind-ended or ventilated type, or be associated with lung cancer or airway damage during endotracheal intubation.
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The authors state that they have no Conflict of Interest (COI).
References
- 1. Takaoka M, Ohnishi H, Ujihara A, Yokoyama A. Multiple tracheal bronchi and a tracheal lobe in the middle mediastinum. Am J Respir Crit Care Med 201: e1-e2, 2020. [DOI] [PubMed] [Google Scholar]
- 2. Unlu EN, Yilmaz Aydin L, Bakirci S, Onbas O. Prevalence of the accessory cardiac bronchus on multidetector computed tomography: evaluation and proposed classification. J Thorac Imaging 31: 312-317, 2016. [DOI] [PubMed] [Google Scholar]