True or Tracheal Bronchus?
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Introduction: Tracheal bronchus is an aberrant bronchus arising from the right lateral wall of the trachea above the carina. The term “pig bronchus” or “bronchus suis” describes an anomalous bronchus supplying the entire right upper lobe, as seen in our case. Case: 81-year-old male with paroxysmal atrial fibrillation, atrial septal defect secundum, congestive heart failure, diabetes mellitus, dilated cardiomyopathy and hypertension presented to the emergency department with nausea and vomiting from the PEG tube. He was admitted for acute hypoxic respiratory failure secondary to aspiration pneumonia. His condition worsened, requiring intubation and transfer to the intensive care unit. Post-intubation chest X-ray showed the endotracheal(ET) tube in place. Despite ventilator and antibiotic optimization, the patient’s condition deteriorated, and the multifocal pulmonary opacities on imaging worsened with trigger additional investigation. Chest Computed Tomography revealed tip of the ET tube at a high takeoff point above the carina. Bronchoscopy confirmed the finding of trachea bronchus and tracheomalacia. The patient was eventually extubated but placed on hospice care and eventually passed away. Discussion: In 1785, Sandifort first described tracheal bronchus as an upper lobe bronchus originating from the trachea. Various origin sites have been studied, with right-sided prevalence higher than left. Anatomical classifications depend on the origin site, can range from the cricoid cartilage to the carina but is usually within 2cm from the carina. It is commonly a congenital anomaly and associated with other congenital conditions like Down Syndrome, heart defects, spinal fusion defect and chromosomal abnormality. It may not manifest any symptoms and maybe incidentally diagnosed on bronchoscopy. There may be some association with recurrent pneumonia, mucus impaction and focal emphysema. Symptoms are usually seen in children but no strong association has been noted in adults. Our patient had recurrent pneumonia with pseudomonas, although he was PEG tube dependent and with concern of improper feeding techniques at home could be a causal factor as well. Chest X-ray and CT Chest occasionally reveal the diagnosis, however, in asymptomatic adults it is incidentally found on bronchoscopy. Treatment is symptomatic management. Complications commonly observed are atelectasis or pneumothorax after anomalous bronchus intubation, inadequate ventilation, recurrent pneumonia and congestive heart failure with coexisting congenital heart anomaly. Conclusion: This condition can be often overlooked in patients with recurrent pulmonary infections or poor ventilatory improvement despite adequate optimization. Careful evaluation in imaging and being aware of different variants can play a critical role in management.
Volume
211
First Page
A1207
Last Page
A1207
Recommended Citation
Desai A, Patel VK. True or tracheal bronchus? Am J Respir Crit Care Med. 2025 May;211:A1207. doi:10.1164/ajrccm.2025.211.Abstracts.A1207
DOI
10.1164/ajrccm.2025.211.Abstracts.A1207
Comments
American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA