Airway and Anaesthetic Challenges in a Child With Bronchus Suis and Superimposed Double Aortic Arch

Abstract

Bronchus suis or tracheal bronchus is an accessory bronchus arising from the trachea above the carina. Double aortic arch is a congenital vascular anomaly with persistence of both left and right aortic arches beyond fetal life which can form a vascular ring compressing the major airways and may be symptomatic. We report the case of a 16-month-old girl who had recurrent episodes of respiratory distress requiring multiple hospitalisations and was diagnosed at the Sultan Qaboos University Hospital, Muscat, Oman in 2019 with a double aortic arch compressing upon a tracheal bronchus causing symptomatic emphysema of the right upper lobe. This report presents anaesthetic and airway challenges during the patient’s lobectomy. A single lumen cuffed endotracheal tube was successfully used as a bronchial blocker to occlude the origin of the aberrant bronchus. The position of the tube was confirmed intraoperatively using fibreoptic bronchoscopy. Following her discharge, she continued to have recurrent episodes of respiratory distress and three months after her last appointment she succumbed to her illness. To the best of the authors’ knowledge, this is the first such reported case in Oman. KEYWORDS Bronchus; Trachea; Aortic Arch; Endotracheal Intubation; Bronchoscopy; Anesthesia; Lobar Pneumonia; Oman.

Forty days old infant with Pig Bronchus, presenting with recurrent pneumonia: A Case Report

“…Rarely, it may cause significant respiratory symptoms owing to retained secretions, resulting in recurrent pneumonia, chronic bronchitis, atelectasis, and difficult airway management in surgical and critical care patients. 5,8 Clinically sometimes, it may put an impression of other rare disorders, such as cystic fibrosis, bronchial fistulas, tracheomegally, recurrent pneumonias due to immune related disorders, etc. Imaging studies such as radiography, computed tomography, and magnetic resonance imaging are the modalities of choice for the identification and diagnosis of various types of TRB.…”