Tracheo-bronchial Angles in Infants and Children

Kubota, Yukio; Toyoda, Yoshiro; Nagata, Noboru; Kubota, Hiroshi; Sawada, Shigehiro; Murakawa, Masahiro; Fujimori, Mitsugu

doi:10.1097/00000542-198603000-00015

Cited by 41 publications

(25 citation statements)

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“…They calculated the mean carinal angle that corresponds to SCA in our study, as 71° in children age 3 years and younger and 67° in children age over 3 years which were smaller than our calculations but also showed a decrease by aging as seen in our study. Unlike Tahir et al [7] we found that RBAs got narrower as the age increases which correlates with most findings in the literature [5,16,17]. According to this finding we can say that RBA gets much narrower than LBA and approaches to midline by aging.…”

Section: Discussionsupporting

confidence: 83%

“…But their study included both children and adults and they did not classify children according to their age. Kubota et al [16] measured the angles in children with different age. They included children between 0–13 years of age and they classified the children into two groups as intubation group and non-intubation group and observed a little difference in RBA and LBA in all ages sum of which makes tracheal bifurcation angle (SCA).…”

Section: Discussionmentioning

confidence: 99%

“…Measurement of IBA was done by drawing lines along the central axis of right and left main bronchi over their length and by measuring the angle formed between the intersection of these lines. Measurements of RBA and LBA were done according to the method described in several reports [5,9,16]. A line was drawn through the longitudinal axis of the trachea.…”

Section: Methodsmentioning

confidence: 99%

“…We assumed that tracheobronchial angle differences might be an explanation to aspiration site in children but literature about the measurements of tracheobronchial angle in children is limited. Kubota et al [16] measured tracheal bifurcation angle on chest radiograms in infants and children between 0–13 years of age and found mean angle value as approximately 80°. They reported that in adults and children not much difference exists in angle values and right bronchial angle (RBA) was always narrower than the left bronchial angle (LBA).…”

Section: Introductionmentioning

confidence: 99%

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Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography

Herek

Ufuk

2017

Clin Exp Otorhinolaryngol

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ObjectivesThe purpose of this study is to investigate if any change exists in the values of tracheal bifurcation angles (subcarinal angle [SCA] and interbronchial angle [IBA]), right and left bronchial angles (RBA and LBA) in different pediatric age groups.MethodsChest computed tomography (CT) images of children aged 18 years and younger were reviewed retrospectively by two radiologists who were blinded to each other’s measurements. One hundred and eighteen children were involved. RBA, LBA, SCA, and IBA were measured on coronal reformatted images. Subjects were classified into three groups according to their age. Measurement of IBA was done by measuring the angle between the lines drawn along the central axis of right and left main bronchi over their length. RBA and LBA were measured at the intersection points of the lines drawn along the inferior borders of the right and left main bronchi and the line passing through the longitudinal axis of trachea. Sums of RBA and LBA gave SCA. Interobserver agreement was also analyzed.ResultsSCA, IBA, and RBA values were statistically significant between children of ages less than 10 years and over 10 years P<0.01). Interobserver agreement was excellent with an intraclass correlation coefficient score of 0.87 (95% confidence interval) for RBA, SCA, and IBA measurements.Conclusion We concluded that tracheal bifurcation angles are wider in children of age 10 years and younger. As age increases values of SCA, IBA, and RBA decrease.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tracheobronchial Angle Measurements in Children: An Anthropometric Retrospective Study With Multislice Computed Tomography

Herek

Ufuk

2017

Clin Exp Otorhinolaryngol

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“…The left mainstem bronchus arises from the trachea at a 45-50 8 angle, whereas the right mainstem bronchus is a relatively straight extension of the trachea (36), and thus more subject to microaspiration. Compared with the RML, which abuts the diaphragm, the RUL is more proximal to the URT source community by the length of the bronchus intermedius (2-3 cm).…”

Section: Discussionmentioning

confidence: 99%

Spatial Variation in the Healthy Human Lung Microbiome and the Adapted Island Model of Lung Biogeography

et al. 2015

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Rationale: The lung microbiome is spatially heterogeneous in advanced airway diseases, but whether it varies spatially in health is unknown. We postulated that the primary determinant of lung microbiome constitution in health is the balance of immigration and elimination of communities from the upper respiratory tract (URT; "adapted island model of lung biogeography"), rather than differences in regional bacterial growth conditions.Objectives: To determine if the lung microbiome is spatially varied in healthy adults.Methods: Bronchoscopy was performed on 15 healthy subjects. Specimens were sequentially collected in the lingula and right middle lobe (by bronchoalveolar lavage [BAL]), then in the right upper lobe, left upper lobe, and supraglottic space (by protected-specimen brush). Bacterial 16S ribosmal RNA-encoding genes were sequenced using MiSeq (Illumina, San Diego, CA). Measurements and Main Results:There were no significant differences between specimens collected by BAL and protectedspecimen brush. Spatially separated intrapulmonary sites, when compared with each other, did not contain consistently distinct microbiota. On average, intrasubject variation was significantly less than intersubject variation (P = 0.00003). By multiple ecologic parameters (community richness, community composition, intersubject variability, and similarity to source community), right upper lobe microbiota more closely resembled those of the URT than did microbiota from more distal sites. As predicted by the adapted island model, community richness decreased with increasing distance from the source community of the URT (P , 0.05).Conclusions: In healthy lungs, spatial variation in microbiota within an individual is significantly less than variation across individuals. The lung microbiome in health is more influenced by microbial immigration and elimination (the adapted island model) than by the effects of local growth conditions on bacterial reproduction rates, which are more determinant in advanced lung diseases. BAL of a single lung segment is an acceptable method of sampling the healthy lung microbiome.Clinical trial registered with www.clinicaltrials.gov (NCT02392182).Keywords: lung; microbiome; bronchoscopy; 16S ribosomal DNA

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