Slide tracheoplasty for congenital tracheal stenosis with involvement of the carina and bronchi: a case report.

A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.

Asociación del complejo ring-sling con pig bronchus: a propósito de un caso pediátrico / Ring-sling complex association with pig bronchus: a pediatric case report

El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

[Ring-sling complex association with pig bronchus: a pediatric case report]. / Asociación del complejo ring-sling con pig bronchus: a propósito de un caso pediátrico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

Bronquio cardíaco diagnosticado por estudio endoscópico / Cardiac bronchus diagnosed by endoscopic study

Introducción: El bronquio cardíaco es una anomalía congénita poco frecuente, con una incidencia de aproximadamente 0,1 por ciento. Consiste en un bronquio supernumerario que nace de la pared medial del bronquio principal derecho o del bronquio intermediario, opuesto al origen del bronquio para el lóbulo superior derecho y proximal al bronquio del segmento apical del lóbulo inferior derecho. Objetivo: Presentar el caso de un bronquio cardíaco diagnosticado por estudio endoscópico. Presentación del caso: Se presenta el caso de un paciente que ingresa en el servicio de Neumología del Hospital Clínico Quirúrgico Hermanos Ameijeiras por presentar tos, expectoración blanca, disnea a los grandes esfuerzos y una radiografía de tórax con una radiopacidad en el lóbulo superior izquierdo y que como hallazgo incidental durante la realización de la broncoscopia se detecta un bronquio cardíaco o supernumerario. Conclusiones: El bronquio cardíaco es una malformación congénita infrecuente que puede cursar de manera asintomática, cuyo diagnóstico definitivo es por broncoscopia(AU)

Introduction: The cardiac bronchus is a rare congenital anomaly, with an incidence of approximately 0.1 percent. It consists of a supernumerary bronchus that arises from the medial wall of the right main bronchus or the bronchus intermediary, opposite the origin of the bronchus for the right upper lobe and proximal to the bronchus of the apical segment of the right lower lobe. Objective: To report the case of a cardiac bronchus diagnosed by endoscopic study. Case report: We report the case of a patient who was admitted to the Pneumology service at Hermanos Ameijeiras Surgical Clinical Hospital due to cough, white expectoration, dyspnea on exertion and a chest X-ray with radiopacity in the upper lobe, and that as an incidental finding during the bronchoscopy, a cardiac or supernumerary bronchus was detected. Conclusions: Bronchus is an infrequent congenital malformation that can be asymptomatic, whose definitive diagnosis is by bronchoscopy(AU)

[Management of unilateral acquired pulmonary bullous emphysema in a premature infant through selective bronchial intubation. Case report and review of literature]. / Manejo de enfisema intersticial unilateral adquirido en un recién nacido prematuro mediante intubación bronquial selectiva: Descripción de un caso y revisión de la literatura.

INTRODUCTION: Acquired pulmonary bullous emphysema is an infrequent complication of assisted ventilation in the premature infant that is difficult to manage. OBJECTIVE: The goal of this report is to present the case of a premature infant who required selective bronchial intubation as well as to provide a review of the current literature on the subject. CLINICAL CASE: The patient is a 27-week gestational age neonatal female patient whose clinical course was complicated by left unilateral bullous emphysema during assisted ventilation for respiratory distress syndrome. Lower peak inspiratory pressures, higher res piratory frequencies, patient positioning, and lower inspiration time failed to improve the patient's condition. The left lung became critically overinflated and compressed the right lung to the point of atelectasis. The patient was selectively mono intubated through the right main bronchus, which resulted in a collapse of the left emphysematous lung. Single right lung ventilation was continued for 48 hours before restarting conventional ventilation of both lungs. Our patient improved significantly, was extubated 6 days after the procedure and later discharged home with normal chest x-ray images. CONCLUSION: Selective bronchial intubation is a safe and effective procedure in cases of acquired bu llous emphysema when usual ventilatory management fails.

Atresia bronquial / Bronchial atresia

Introducción: La atresia bronquial es una patología poco frecuente, generalmente asintomática e incidental en las imágenes del tórax. La aproximación diagnóstica de esta entidad se puede hacer por radiografía y broncoscopia, donde se identifican algunos aspectos claves en el diagnóstico diferencial. De acuerdo las manifestaciones clínicas y posibles complicaciones el tratamiento puede ser desde conservador hasta quirúrgico con resección lobar o segmentaria. Objetivo: Presentar las características de un caso con atresia bronquial. Presentación de caso: Se presenta un caso de atresia bronquial en una paciente de 19 años de edad cuyo tratamiento definitivo fue bilobectomía media-inferior derecha. Conclusiones: La atresia bronquial es una entidad infrecuente que puede cursar de manera asintomática y ser detectada por un hallazgo radiológico en pacientes adultos de manera incidental. El diagnóstico se puede confirmar por broncoscopia y el tratamiento casi siempre es quirúrgico(AU)

Introduction: Bronchial atresia is a rare disease, generally asymptomatic and incidental in chest images. The diagnostic approach of this entity can be done by radiography and bronchoscopy, some key aspects are identified in the differential diagnosis. According to the clinical manifestations and possible complications, the treatment can range from conservative to surgical with lobar or segmental resection. Objective: To describe a case of bronchial atresia. Case report: A case of bronchial atresia is reported in a 19-year-old patient whose definitive treatment was a right-lower-middle bilobectomy. Conclusions: Bronchial atresia is a rare entity that can occur asymptomatically and be detected incidentally by a radiological finding in adult patients. The diagnosis can be confirmed by bronchoscopy, and treatment is almost always surgical(AU)

[Thoracoscopic lobectomy for the treatment of tracheal bronchus. A pediatric case report]. / Lobectomía toracoscópica para el tratamiento del bronquio traqueal. Reporte de un caso pediátrico.

BACKGROUND: Tracheal bronchus is considered a rare, congenital anomaly, which implies the abnormal origin of a bronchus. When related to repetitive infections the bronchus must be resected, usually via an open procedure. OBJECTIVE: The aim of this paper is to present the case of a patient with tracheal bronchus of the upper right lobe who presented with repetitive pneumonias. Additionally, this text intends to expose the methodology for its diagnosis and surgical resolution through a thoracoscopic lobectomy. CLINICAL CASE: One year old female patient who presented with the disorder at two months of age. The patient presented with constant coughing and persistent fever alongside repetitive pneumonias in the upper right lobe. In order to discard the possibility of gastroesophageal reflux, a bronchoscopy and a panendoscopy of the digestive tube were conducted. The aforesaid procedure demonstrated the existence of a tracheal bronchus located in the right lobe, with functional bronchial segmentation. With these findings and due to the presence of repetitive infections, an apical right lobectomy was performed through a thoracoscopy, with favourable results. CONCLUSIONS: Tracheal bronchus is a rare anomaly that on many occasions is asymptomatic; nonetheless, when related to repetitive infections, a lobectomy must be carried out to avoid further pulmonary damage. This can be done through a thoracoscopy, as was the case with our patient. When treating these patients, it is worth considering they tend to have a different anatomy and to consider the ease at which they can sustain severe inflammation due to repetitive infections.

Prominent Intrapulmonary Bronchopulmonary Anastomoses and Abnormal Lung Development in Infants and Children with Down Syndrome.

OBJECTIVES: To determine the frequency of histologic features of impaired lung vascular and alveolar development and to identify the presence of intrapulmonary bronchopulmonary anastomoses (IBA) in infants and children who died with Down syndrome. STUDY DESIGN: A retrospective review of autopsy reports and lung histology from 13 children with Down syndrome (ages: 0-8 years) was performed. Histologic features of abnormal lung development were identified and semiquantified, including the presence of IBA. Three-dimensional reconstructions of IBA were also performed. Comparisons were made with 4 age-matched patients without Down syndrome with congenital heart defects who underwent autopsies during this time period. RESULTS: Of the 13 subjects with Down syndrome, 69% died from cardiac events, 77% had a congenital heart defect, and 46% had a clinical diagnosis of pulmonary hypertension. Lung histology from all subjects with Down syndrome demonstrated alveolar simplification, and 92% had signs of persistence of a double capillary network in the distal lung. The lungs from the subjects with Down syndrome frequently had features of pulmonary arterial hypertensive remodeling (85%), and prominent bronchial vessels and IBA were observed in all subjects with Down syndrome. These features were more frequent in subjects with Down syndrome compared with control subjects. CONCLUSIONS: Children with Down syndrome who died of cardiopulmonary diseases often have histologic evidence of impaired lung alveolar and vascular development, including the presence of prominent IBA and pulmonary hypertension. We speculate that children with Down syndrome are at risk for reduced lung surface area and recruitment of IBA, which may worsen gas exchange in subjects with Down syndrome.

Bronquio cardíaco accesorio y otras variantes de la anatomía tráqueo-bronquial / Accessory cardiac bronchus and others variations of the tracheobronchial anatomy

Entre las variantes de la anatomía bronquial nos podemos encontrar con ramas bronquiales displásicas, ramas ausentes o ramas supernumerarias. Aunque gran parte son asintomáticas, es esencial reconocerlas porque se pueden asociar a hemoptisis, infecciones recurrentes, empiema o a complicaciones secundarias a procedimientos (por ejemplo intubaciones endotraqueales, fibrobroncoscopías, lavado broncoalveolar, biopsias, tratamientos endobronquiales, instalación de stent, braquiterapia y cirugías pulmonares entre otros). En este articulo describimos las variantes bronquiales más prevalentes en tomografia computada, incluyendo al bronquio cardíaco accesorio, bronquio traqueal y bronquio puente, entre otras.

Among the variations of bronchial anatomy, we can find dysplastic bronchial branches, an absence of bronchial branches, or supernumerary branches. Although many of them are asymptomatic, it is essential to know them because they may be associated with hemoptysis, recurrent infections, empyema, or complications secondary to various procedures (e.g. endotracheal intubation, brochoscopy, bronchoalveolar lavage, biopsy, endobronchial treatments, stent installation, brachytherapy and lung surgeries among others). In this study we used computed tomography to describe some of the most prevalent bronchial variations, including accessory cardiac bronchus, tracheal bronchus, and bridge bronchus among others.

Developmental anomalies of bronchial tree: a multidetector computerized tomography study / Anomalías del desarrollo del árbol bronquial: un estudio mediante tomografía computarizada multidetector

Anomalies of the bronchial tree may cause recurrent acute pulmonary infection and persistent obstruction symptoms. The developmental anomalies of the bronchial tree were presented mostly as case reports with an accompanying anomaly. However in this study, these anomalies were detected in multidetector computerized tomography (MDCT) images which have no reported pathology. Thoracic MDCT images of 400 patients (0-74 years old, 224 male and 176 female) were evaluated. Four tracheal bronchus (1percent) were detected. Three of them were displaced type, one of them was pig bronchus. And two accessory cardiac bronchus (0,5 percent) originated from medial wall of the intermediate bronchus were detected. According to our findings, incidence of tracheal bronchus and accessory cardiac bronchus seems to be higher in Turkish population.

Las anomalías del árbol bronquial pueden causar una infección pulmonar aguda recurrente y síntomas de obstrucción persistente. Las anomalías del desarrollo del árbol bronquial se presentan principalmente como informes de casos con una anomalía de acompañante. Sin embargo, en este estudio se detectaron estas anomalías en las imágenes de tomografía computarizada multidetector (TCMD), donde no se habían informado esta patología. Se evaluaron las imágenes de TCMD torácica de 400 pacientes (0-74 años, 224 hombres y 176 mujeres). Se detectaron cuatro bronquios traqueales (1 por ciento). Tres de ellos fueron de tipo desplazado, uno fue tipo bronquio de cerdo, y dos bronquio cardiaco accesorio (0,5 por ciento), originados de la pared medial del bronquio intermedio. De acuerdo con nuestros resultados, la incidencia de bronquio traqueal y bronquios cardiacos accesorios parecen ser mayor en la población turca.

Bronquio traqueal / Tracheal bronchio

Tracheal bronchus is considered an anatomical variant or bronchial malformation. Its clinical manifestations are rare, and are due to a failure to drain bronchial secretions. Anatomically it may be a supernumerary or ectopic bronchus. His diagnosis is made by direct visualization of images and airway. Generally its treatment is expectant.

El bronquio traqueal es considerado como una variante anatómica o malformación bronquial. Sus manifestaciones clínicas son infrecuentes, y se deben a una falla para el adecuado drenaje de secreciones bronquiales. Anatómicamente puede tratarse de un bronquio supernumerario o ectópico. Su diagnóstico se realiza mediante imágenes y visualización directa de la vía aérea. En general su tratamiento es expectante.