title: Incidental left main bronchus obstruction during left-sided double-lumen tube intubation of a patient with an unrecognized tracheal bronchus: A case report.
abstract: BACKGROUND
  Tracheal bronchus is a right-sided anomalous bronchus arising from the trachea above the main carina and occurs in 0.1% to 2% of the general population.
  
  
  METHODS
  We present a case of left main bronchus obstruction during a left-sided double-lumen tube intubation in a patient with an unrecognized tracheal bronchus. After the intubation, to confirm the position of the tube, we observed what we believed was the carina with a fiberoptic bronchoscope, but it was a site between the tracheal bronchus and the right main bronchus. Thus, a right-sided intubation was performed, and the left main bronchus was obstructed with a bronchial cuff. As a result of the inappropriate ventilation, peak inspiratory pressure was elevated and arterial oxygen saturation decreased.
  
  
  CONCLUSIONS
  Anesthesiologists should keep in mind the possibility of anatomical variation in the large airways, and bronchoscopy should be accompanied by cautious auscultation and confirmation of the division of the bronchus.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Korea Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Chungcheongnam-do, Korea.
authors.forename: Ho Bum
authors.initials: HB
authors.lastname: Cho
authors.forename: Hyoung June
authors.initials: HJ
authors.lastname: Kim
authors.forename: Hyung Youn
authors.initials: HY
authors.lastname: Gong
authors.forename: Mun Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology*; D001980:Bronchi / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001999:Bronchoscopy; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000002:abnormalities* / Q000000981:diagnostic imaging