title: Challenging lung isolation secondary to aberrant tracheobronchial anatomy.
abstract: Aberrant tracheobronchial anatomy is reported at an incidence of approximately 10% and most frequently involves the segmental and subsegmental bronchi. The most relevant abnormality to the practice of anesthesiology is the presence of a tracheal bronchus. Although typically an asymptomatic finding during bronchoscopy, a tracheal bronchus has important implications for airway management and lung isolation. Coexisting abnormalities may further complicate lung isolation. We describe a patient with a tracheal bronchus, coexisting with a left-shifted carina and apically retracted left mainstem bronchus, presenting for right extrapleural pneumonectomy. Attempts to place a left-sided double-lumen endotracheal tube were unsuccessful. We discuss our solution, review the literature, and present potential solutions for lung isolation in patients with a tracheal bronchus.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA. swiser@partners.or
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Wiser
authors.forename: Philip M
authors.initials: PM
authors.lastname: Hartigan
mesh_terms: D000368:Aged; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D001980:Bronchi / Q000002:abnormalities*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008168:Lung / Q000502:physiology; D008297:Male; D014132:Trachea / Q000002:abnormalities*