Presence of tracheal bronchus in children undergoing flexible bronchoscopy

Ruchonnet-Métrailler, Isabelle; Taam, Rola Abou; Blic, J. de

doi:10.1016/j.rmed.2015.04.005

Cited by 28 publications

(35 citation statements)

References 23 publications

(17 reference statements)

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“…This finding supports the “space available” hypothesis of LPAS embryology proposed by Chen et al, 9 who hypothesized that patients with LPAS might have hypoplastic primitive upper respiratory trees during embryogenesis and that the embryonic peritracheal mesenchyme is widened to provide ample space for the left lung bud plexus to approach the right sixth branchial arch. Neither the present nor any previous, studies have reported the finding of true TB on the left side 15,18,19 . This preference for bronchial maldevelopment on the right side in the embryonic period create more space on the ipsilateral side.…”

Section: Discussioncontrasting

confidence: 77%

Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling

Fukushima

Shimojima

Ishitate

et al. 2020

Pediatric Pulmonology

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Objectives To identify the imaging features peculiar to congenital tracheal stenosis (CTS) complicated with left pulmonary artery sling (LPAS) with the aim of presenting a hypothesis of tracheal stenosis embryology in LPAS. Methods We retrospectively reviewed CTS patients (with complete cartilaginous rings) admitted between April 2010 and July 2018. All the patients were classified into the LPAS or non‐LPAS group, and their clinical characteristics and qualitative variables on computed tomography (CT) imaging were compared. Results Of the 72 patients enrolled, 61 had bilateral lungs. Among the bilateral lung patients, 26 (43%) had LPAS. The tracheal bifurcation was significantly deeper, the stenotic region was longer, and the bronchial angle (especially in the right) was wider, in the LPAS group. The cut‐off values for the thoracic vertebral level at the tracheal bifurcation (>4.8), subcarinal angle (>118.1), and right bronchial angle (>61.9) were useful for diagnosing suspected cases of LPAS. In the time‐dependent course, LPAS complicated with a congenital heart defect was a statistically significant risk factor of respiratory symptoms (hazard ratio, 3.01; 95% confidence interval, 1.23‐7.37; P = .02). Conclusions The CT findings described here should immediately raise suspicion of LPAS on chest X‐ray and also suggest tracheal “squeezing and milking” by the surrounding vessels in the embryo. Patients with LPAS complicated with a heart defect should be followed carefully to determine the optimal timing of intervention.

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Section: Discussioncontrasting

confidence: 77%

Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling

Fukushima

Shimojima

Ishitate

et al. 2020

Pediatric Pulmonology

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“…From an embryological standpoint, TRB develops between the 3rd and 7th week of gestation from an anomalous tracheal sprout which does not undergo regression or through implantation of bronchial mesenchyma within the trachea . It is usually associated with a wide variety of congenital anomalies or syndromes . As far as we know, this series is the most extensively described to date since most of the published data on TRB corresponds to case reports or small series of patients .…”

Section: Discussionmentioning

confidence: 94%

“…The term “tracheal bronchus” (TRB) was initially described by E. Sandifort in 1785 and was defined as a bronchus that originates directly from the lateral wall of the trachea, at any level between the cricoid cartilage and the carina, leading to the territory of the right upper lobe . Its incidence varies according to the diagnostic method employed and is considered to be present in approximately 0.2% to 3% of paediatric patients in whom a bronchoscopy is performed …”

Section: Introductionmentioning

confidence: 99%

“…Although TRB usually originates from the right side of the trachea, some cases arising from the left side have been described too, besides bilateral locations . Conacher et al classified TRB according to the exit level from the trachea: type I, arising from the junction of the middle and lower tracheal third with a decrease in the distal tracheal diameter; type II, coming from the lower third without modification of the tracheal size; and type III, arising almost at the level of the carina and giving the appearance of a trifurcated carina (Figure and Figure ) .…”

Section: Introductionmentioning

confidence: 99%

“…Excluding a recent publication with 57 cases (3), most of the scientific literature on this topic consists on case reports or small series of patients which usually describe respiratory symptoms associated to recurrent pneumonia and/or persistent atelectasis . Due to the limited experience reported, it has been difficult to establish a causal relationship between the patients' symptoms and the presence of TRB, therefore, considering it a mere anatomical finding.…”

Section: Introductionmentioning

confidence: 99%

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Spanish multicentre study on morbidity and pathogenicity of tracheal bronchus in children

Moreno

Castillo‐Corullón

Pérez-Ruíz³

et al. 2019

Pediatric Pulmonology

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Tracheal bronchus (TRB) has been generally considered an anatomical variant of the tracheobronchial tree without a precise pathological effect. Its prevalence is estimated to be between 0.2% to 3% of all children undergoing bronchoscopy and scientific information has been limited to case reports or small case series. Our working hypothesis was that TRB could trigger by itself recurrent or persistent respiratory symptoms. The objective of this retrospective and multicentre study of children with a diagnosis of TRB, coming from the main paediatric pulmonology units of Spain, was to determine the anatomical and clinical characteristics, including comorbidities, of TRB in childhood and their impact in the patients' clinical outcomes. One hundred thirty‐three patients from 13 institutions were included in the study. Mean diagnostic age was 3.4 years and flexible bronchoscopy was the initial diagnostic method in 85% of cases. All TRB were located on the right wall of the trachea: 76% in the lower third and 24% in the carina. The most common clinical manifestations were obstructive bronchitis (53.3%) and recurrent pneumonia (46.6%), usually affecting the right upper lobe. Regarding associated anomalies, 33% had tracheomalacia, 32% congenital cardiovascular malformations, 28% gastroesophageal reflux, 22.5% congenital tracheal stenosis, and 8.3% Down syndrome. This series appears to be the most extensive published to date addressing this topic and, according to our data, TRB does not appear to be a mere incidental finding but is more likely linked to a wide range of congenital anomalies and contributes by itself to the recurrent respiratory symptomatology that these children exhibit.

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Anatomy and Physiology of the Airway Applied Aspects

Shetty

Archana

2023

The Airway Manual

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Presence of tracheal bronchus in children undergoing flexible bronchoscopy

Cited by 28 publications

References 23 publications

Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling

Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling

Spanish multicentre study on morbidity and pathogenicity of tracheal bronchus in children

Anatomy and Physiology of the Airway Applied Aspects

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