title: Difficulty in placement of a left-sided double-lumen tube due to aberrant tracheobronchial anatomy.
abstract: A rare case of a tracheal bronchus coexisting with a left-shifted carina and an acute angle of left main bronchus is presented. A 66 year old man with a history of colon cancer was scheduled for right thoracoscopic pericardial window due to recurrent pericardial effusion. After induction of anesthesia, the trachea was intubated using a 39-French, left-sided double lumen tube (DLT); the DLT was positioned with fiberoptic bronchoscopic guidance. Significantly high airway pressure was noticed as we initiated one-lung ventilation after the patient was positioned in the left lateral decubitus position. While repositioning the DLT, we found an aberrant tracheal bronchus. Although multiple attempts were made to adjust the DLT so as to achieve lung isolation, we could not place the DLT in the appropriate position due to abnormal and distorted anatomy. Lung isolation was unsuccessful; both lungs were carefully ventilated with small tidal volumes.
authors: Department of Anesthesiology, Shin-yurigaoka General Hospital, Kanagawa, 215-0026, Japan. Electronic address: tatsuya.yoshi@gmail.com.
authors: Tatsuya
authors: T
authors: Yoshimura
authors: Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
authors: Ken-Ichi
authors: KI
authors: Ueda
authors: Department of Anesthesia, Teikyo University Hospital, Tokyo, 173-8605, Japan.
authors: Akihito
authors: A
authors: Kakinuma
authors: Graduate School of Public Health, Teikyo University, Tokyo, 173-8605, Japan.
authors: Yoshinori
authors: Y
authors: Nakata
mesh_terms: D000368:Aged; D001980:Bronchi / Q000002:abnormalities*; D001999:Bronchoscopy / Q000379:methods; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D061810:One-Lung Ventilation / Q000379:methods; D010490:Pericardial Effusion / Q000601:surgery*; D010491:Pericardial Window Techniques; D013906:Thoracoscopy / Q000379:methods; D013990:Tidal Volume; D014132:Trachea / Q000002:abnormalities*
keywords: Aberrant tracheal anatomy; Double-lumen endotracheal tube; Lung isolation; One-lung ventilation; Tracheal bronchus