Anesthetic Management of One-Lung Ventilation in Patients With Tracheal Bronchus: A Narrative Review.

Tracheal bronchus is a rare congenital tracheal abnormality that generally refers to the right upper lobe bronchus of the lung that originates from the trachea. Tracheal bronchus is usually asymptomatic and is often accidentally detected by fiberoptic bronchoscopy or computed tomography for other conditions. Depending on the location of the tracheal bronchial opening and possible anatomical variations, the management of 1-lung ventilation in patients with tracheal bronchus is a significant challenge for anesthesiologists. To provide a reference for anesthesiologists to better manage anesthesia in such patients, we review the pathophysiology, definition, and Conacher classification of tracheal bronchus and then discuss the diagnosis of tracheal bronchus and management of 1-lung ventilation during anesthesia according to the Conacher classification.

A rare duo: Pulmonary arterial sling with a pig bronchus.

Pulmonary artery sling is an incomplete vascular ring, where the left pulmonary artery originates from the right pulmonary artery, leading to airway constriction. A tracheal bronchus is an anatomical variation in which an extra bronchus originates from the trachea, frequently resulting in respiratory symptoms or complications. We report a 6-week-old female patient with a pulmonary artery sling coursing around the distal trachea and a concurrent tracheal bronchus.

Global, regional, and national burden and trends of early-onset tracheal, bronchus, and lung cancer from 1990 to 2019.

BACKGROUND: Tracheal, bronchus, and lung cancer (TBL) is one of the main cancer health problems worldwide, but data on the burden and trends of early-onset tracheal, bronchus, and lung cancer (EO-TBL) are sparse. The aim of the present study was to provide the latest and the most comprehensive burden estimates of the EO-TBL cancer from 1990 to 2019. METHODS: Overall, we used data from the Global Burden of Disease (GBD) study in EO-TBL cancer from 1990 to 2019. Evaluation metrics included incidence, mortality, and disability-adjusted life years (DALYs). The joinpoint regression model was used to analyze the temporal trends. Decomposition analysis was employed to analyze the driving factors for EO-TBL cancer burden alterations. Bayesian age-period-cohort (BAPC) analysis was used to estimate trends in the next 20 years. RESULTS: The global age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for EO-TBL cancer decreased significantly from 3.95 (95% uncertainty interval [UI]: 3.70-4.24), 3.41 (95% UI: 3.19-3.67), 158.68 (95% UI: 148.04-170.92) in 1990 to 2.82 (95% UI: 2.54-3.09), 2.28 (95% UI: 2.07-2.49), 106.47 (95% UI: 96.83-116.51) in 2019 with average annual percent change (AAPC) of -1.14% (95% confidence interval [CI]: -1.32 to -0.95), -1.37% (95% CI: -1.55 to -1.18), and - 1.35% (95% CI: -1.54 to -1.15) separately. The high and high-middle sociodemographic index (SDI) region had a higher burden of EO-TBL cancer but demonstrated a downward trend. The most prominent and significant upward trends were Southeast and South Asia, Africa, and women in the low SDI and low-middle SDI quintiles. At the regional and national level, there were significant positive correlations between ASDR, ASIR, ASMR, and SDI. Decomposition analysis showed that population growth and aging have driven the increase in the number of incidence, mortality, and DALYs in the global population, especially among the middle SDI quintile and the East Asia region. The BAPC results showed that ASDR, ASIR, and ASMR in women would increase but the male population remained relatively flat over the next 20 years. CONCLUSIONS: Although global efforts have been the most successful and effective in reducing the burden of EO-TBL cancer over the past three decades, there was strong regional and gender heterogeneity. EO-TBL cancer need more medical attention in the lower SDI quintiles and in the female population.

Use of an Endobronchial Blocker in a Patient with Tracheobronchial Anomaly for Minimally Invasive Cardiac Surgery: A Case Report.

Tracheal bronchi (TB) is a rare anomaly and is usually asymptomatic. Although it is generally not a problem when a single lumen tube is used, it may cause ventilation difficulties in the intraoperative period in procedures requiring one lung ventilation, such as minimally invasive cardiac surgery. Therefore, these difficulties may cause intraoperative and postoperative complications. While a double-lumen tube is recommended as the primary choice for one-lung ventilation in patients with TB, bronchial blockers can be used to avoid the need for tube exchange in patients who will remain intubated in the postoperative period.

Temporal trends in disease burden and attributable risk factors for tracheal, bronchus, and lung cancer in Nepal, 1990-2019.

BACKGROUND: Tracheal, bronchus, and lung (TBL) cancer is one of the most common cancers in Nepal. The aim of this study was to analyze the changing disease burden and risk factors for TBL cancer in Nepal from 1990 to 2019. METHODS: TBL cancer burden data were obtained from the Global Burden of Disease Study 2019. A decomposition analysis was used to explore the impact of changes in population size, population age structure, age-specific prevalence, and disease severity on long-term trends of the TBL cancer burden in Nepal. RESULTS: In 2019, TBL cancer resulted in the loss of 45.2 thousand (95% uncertainty interval [UI]: 32.3-59.2 thousand) disability-adjusted life years (DALYs) in Nepal, with the age-standardized incidence and prevalence rates increasing by 12.7% (95% UI: -21.0 to 63.9%) and 12.8% (95% UI: -21.1 to 62.0%), respectively, compared with 1990. The proportion of DALYs due to TBL cancer increased significantly among people aged 70 years and older from 1990 to 2019. However, the proportion of DALYs due to TBL cancer still dominated among males and females aged 50-69 years. Population growth, population aging, and increased age-specific prevalence led to an increased disease burden of TBL cancer, while disease severity led to a decreased burden. In 2019, smoking remained the major risk factor for TBL cancer in Nepal, while ambient particulate matter pollution exhibited the most significant rise. CONCLUSIONS: The disease burden of TBL cancer in Nepal has continued to increase over the past three decades, and given the continuing population growth and aging process, TBL cancer is likely to have a considerable impact on health in Nepal in the future. There is a need to further establish effective TBL cancer prevention and control policies.

Global, regional, and national burden of tracheal, bronchus, and lung cancers attributable to high fasting plasma glucose: A systematic analysis of global burden of disease 2019.

BACKGROUND: Tracheal, bronchus, and lung (TBL) cancer is the third most common and lethal type of cancer worldwide. Glucose metabolism disorders, as represented by high fasting plasma glucose (HFPG), increase the risk of development and worsen the prognosis of TBL cancer. This study aimed to evaluate the global disease burden of TBL cancer attributable to HFPG. METHODS: The TBL cancer burden attributable to HFPG was estimated based on a modeling strategy using the Global Burden of Disease Study 2019. The disease burden globally and by regions, countries, development levels, age groups, and sexes were also evaluated with the indicators of death, disability-adjusted life years, years of life lost, and years lived with disability. The estimated annual percentage change (EAPC) was calculated by regression model to show the temporal trend. RESULTS: In 2019, approximately 8% of the total TBL cancer burden was attributable to HFPG. The HFPG-attributable TBL cancer burden increased globally from 1990 to 2019 with the EAPC of 0.98% per year. The burden was positively associated with social development levels, and the global burden was three times greater in men than in women. HFPG-attributable TBL cancer burden increased with age and peaked at above 70 years of age. CONCLUSIONS: The findings highlight the effect and burden of glucose disorders, as represented by HFPG on TBL cancer burden. Integrated cancer prevention and control measures are needed, with control of glucose disorders as one of the key elements.

Left Bronchial Isomerism with Right-Sided Tracheal Bronchus: A Rare Case Report.

The tracheal bronchus is a congenital bronchial branching anomaly defined as an aberrant bronchus arising in either the trachea or a main bronchus. Left bronchial isomerism is characterized by two bilobed lungs, bilateral long main bronchi, and both pulmonary arteries passing superiorly to their respective upper lobe bronchi. Left bronchial isomerism with a right-sided tracheal bronchus is a very rare combination of tracheobronchial anomalies. It has not been previously reported. We present multi-detector CT findings of a left bronchial isomerism with a right-sided tracheal bronchus of a 74 year old man.

Tracheal Bronchus and Successful Right-Sided Isolation With a Bronchial Blocker.

The presence of a tracheal bronchus, which is often incidentally discovered, complicates endotracheal intubation and lung isolation during thoracic surgery. Prior reports of successful right-sided lung isolation in the presence of tracheal bronchus required utilization of a double lumen tube. Although right-sided lung isolation was required in our case, due to other patient factors, it was determined that a double lumen tube of a suitable size would be unlikely to be placed safely and successfully. We describe the successful use of a Rüsch EZ-Blocker bronchial blocker in obtaining right-sided isolation in a patient with a difficult airway and tracheal bronchus.

Tracheal Bronchus Detected During General Anesthesia: A Case Report.

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skin grafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentally observed at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not used in many anesthesia cases, making the identification of such tracheal or bronchial abnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without neglecting routine safety checks.

Rare laryngotracheobronchial anomalies in children: a retrospective study of 249 bronchoscopic cases in a single center.

Background: Laryngotracheobronchial anomalies in children are rare, and their clinical manifestations are diverse. In this study, we report the clinical aspects and prevalence rates of tracheal bronchus (TB) and congenital subglottic stenosis (CSS) in a select group of patients at our institution and briefly review and discuss the literature to draw attention to these rare anomalies. Case series: We retrospectively reviewed the clinical records of 249 children for whom senior surgeons performed rigid bronchoscopy for suspected or confirmed food choking or foreign body aspiration in children between August 2013 and January 2020. Bronchoscopic findings and demographics of the patients with laryngotracheobronchial anomalies were documented. Four among the 249 patients (1.6 %) had right-sided TB (two males aged 24 and 42 months and two females aged 14 and 60 months), while three (1.2 %) had grade 1 CSS (one male aged eight months and two females aged 11 and 13 months). There was no previous history of endotracheal intubation for any subglottic stenosis (SS), though all three patients were admitted with sudden onset of respiratory difficulty. One of the TB cases had congenital cardiac anomalies, and two were symptomatic before their admission to the emergency department. Conclusions: The prevalence of CSS and TB in the healthy population is low. Physicians dealing with the pediatric airways should consider such anomalies for prompt diagnosis, proper instrumentation, management, and follow-up of these cases. Our data also correlate with previous data, indicating that these anomalies' prevalence rates have not increased during the last few decades. HIPPOKRATIA 2023, 27(2):59-63.

A Review of Tracheal Bronchus in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).

Tracheal bronchus (TB) is a rare congenital anomaly described as a abnormal bronchus that originates directly from the trachea above the carina directed towards the upper lung lobe. We analysed all paediatric rigid endoscopies of the airway from January 2015 until August 2020 to determine the incidence and characteristic of TB. In total, 68 rigid endoscopic airway examination record from children aged 0 to 12 years were analyzed. Endoscopic examination was performed from supraglottic region to carina using a 0 degree Hopkins rod lens telescope. Patients with a TB were identified and the site of TB origin was noted. Data of the identified patients was reviewed for the presence of preoperative airway findings such as stridor, upper lobe pneumonia, other congenital anomalies, intraoperative findings and complications and postoperative general condition outcome. TB was detected in 8 (11.8%) of 68 airway endoscopic examinations. 6 children (75%) were syndromic. 5 patients (62.5%) has congenital malacic airway and 2 patients (25%) has congenital tracheal stenosis. All TB originated from the right lateral wall of the trachea. All children had stridor unrelated to TB as presentation and 4 (50%) of children had preoperative upper lobe pneumonia. Tracheal bronchus is not a rare finding and is highly associated with syndromes and other airway anomalies. Although children with TB can be asymptomatic, upper lobe pneumonia is a common presentation. TB should be included in the differential diagnosis in patients with recurrent right upper lobe pneumonia or collapse and patients with unexplained oxygenation problem during endotracheal intubation, particularly in children with syndromes or other congenital anomalies.

Tracheal bronchus and associated pathologies detected by multidetector-row computed tomography in the Vietnamese population.

Tracheal bronchus (TB) is a very rare condition, which is often associated with some other pathologies. This study was designed to characterize the morphology of tracheal bronchus and associated pathologies in Vietnamese individuals using multidetector-row computed tomography (MDCT). From August 2016 to February 2021, 16, 64-, and 128-detector-row computed tomography scanners were used to perform chest scans of 3663 patients, of whom 32 had tracheal bronchus and associated pathologies. The prevalence of tracheal bronchus was 0.9%, of which 0.6% were male and 0.3% were female. We found that one patient had bilateral tracheal bronchus (3.1%) and 31 patients (96.9%) had right-sided tracheal bronchus. Most patients (75.1%) had type II tracheal bronchus, whereas 15.6% and 6.2% had type III and type I tracheal bronchus, respectively. The average distance from the tracheal bronchus to the carina was 6.6 ± 6.4 mm. The average diameter of the tracheal bronchus was 4.4 ± 2.2 mm; the group with 2-4-mm tracheal bronchus accounted for the highest proportion (46.9%). Associated pathologies included congenital heart diseases (i.e., valvular heart disease, tetralogy of Fallot, cyanotic congenital heart disease-APSO, and aortic coarctation) (43.7%), stenosis of the bilateral pulmonary arteries (15.6%), absent left pulmonary artery (6.2%), stenosis of the right pulmonary artery (3.1%), anomalous pulmonary venous connection (3.1%), stenosis of the trachea (3.1%), stenosis of the left main bronchus (3.1%), bronchogenic cyst (3.1%), and bronchial atresia (3.1%), and the remaining 12.5% had no abnormalities. tracheal bronchus is a very rare abnormality among Vietnamese and is often accompanied by other pathologies. MDCT with a high spatial resolution and a good tissue contrast, along with contrast agent and appropriate scanning protocols, is efficient in detecting tracheal bronchus and associated pathologies.

Intraoperative Diagnosis of "Bronchus Suis", a Variant of Tracheal Bronchus.

Bronchus suis, also known as tracheal bronchus, is a rare congenital anatomic variant in which an aberrant bronchus develops above the carina. Often asymptomatic, bronchus suis may be detected during imaging or manipulation of the airway. Here we describe a case where bronchus suis was visualized by fiberoptic bronchoscopy performed intraoperatively for the evaluation of desaturation and management of endotracheal secretions. It is important for anesthesiologists to consider the possibility of tracheal bronchus in patients with acute respiratory compromise.

Foreign Body Aspiration in a Child With a Rare Tracheal Bronchus.

A tracheal bronchus is an unusual bronchial division anomaly in which an accessory bronchus arises from the trachea or main bronchus and travels to the higher lobe territory. This report discusses a case of incidentally diagnosed tracheal bronchus after foreign body removal via bronchoscopy. A one-year-old boy presented to the hospital with cough and noisy breathing after choking on peanuts. On examination, he had mild tachypnea with non-prominent subcostal retractions and diminished airflow in the left lung. Rigid bronchoscopy revealed a foreign body in the trachea at the level of the left main bronchus, which was completely removed in one piece under vision using fiberoptic forceps. A tracheal bronchus is an unusual congenital abnormality, with most cases being asymptomatic. Appropriate reporting of such anomalies may help healthcare practitioners promptly diagnose, manage, and avoid complications in the tracheal bronchus.

Case report: A rare combination of right aortic arch with right patent ductus arteriosus and right tracheal bronchus causing impaired respiratory function.

A right aortic arch with concomitant right patent ductus arteriosus and right tracheal bronchus is a rare congenital anomaly. Herein, the respiratory and circulatory functions of the child were normal at early ages, and imaging examination indicated that conservative treatment was suitable. However, with the growth and development of the child, the right tracheal bronchus was oppressed by the right arterial duct. We performed a cut and ligation of the right patent ductus arteriosus to relieve the pressure on the right tracheal bronchus. At the 6-month follow-up, the child had recovered well and exhibited no symptoms of respiratory restriction. Therefore, we believe that early interventions should be considered for this rare anatomic presentation to benefit the patient's respiratory and circulatory systems. Our experience provides a foundational reference for future cases.

One-lung ventilation and 3D image analysis in a case of tracheal bronchus with steeply angled branching of left main bronchus: a case report.

BACKGROUND: Establishing one-lung ventilation (OLV) in patients with tracheal bronchus (TB) may be challenging due to its unusual bronchial anatomy. We present a case of difficult OLV in a patient with right TB and steeply angled bifurcation of the left main bronchus. CASE PRESENTATION: A 79-year-old woman was scheduled to undergo video-assisted thoracic surgery left upper lobectomy. We planned right OLV with a bronchial blocker; however, it was difficult to place the blocker in the left main bronchus due to a steep bifurcation angle. Therefore, we changed the entry angle of the lumen tip by advancing the tracheal tube to just above the tracheal bifurcation, allowing successful placement of the bronchial blocker into the bronchus. CONCLUSION: For airway management in patients with TB, especially for OLV, it is essential to understand the anatomy of the trachea, bronchus, and TB and to select the appropriate device for each case.