Variations of the tracheobronchial tree: Anatomical and clinical significance

Wooten, Candace; Patel, Swetal; Cassidy, Lindsey; Watanabe, Koichi; Matusz, Petru; Tubbs, R. Shane; Loukas, Marios

doi:10.1002/ca.22351

Cited by 47 publications

(34 citation statements)

References 56 publications

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“…This preference for bronchial maldevelopment on the right side in the embryonic period create more space on the ipsilateral side. In the present study, true TB (the anomalous, displaced or rudimentary type as described by Wooten et al 20 ) or dimple was encountered significantly more often in the LPAS group among bilateral lung cases. This high prevalence supports the “space available” hypothesis described above.…”

Section: Discussionsupporting

confidence: 68%

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: Discussionsupporting

confidence: 68%

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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“…They suggested that this syndrome, also known as visceral heterotaxy, “is a severe variant of situs inversus which involves a complete breakdown in the classical asymmetry found in the abdominal viscera.” It is questionable whether the constellation of abnormal findings is a “severe variant of situs inversus.” Rather, the “breakdown in classical asymmetry” is of greatest significance, but this involves not only the abdominal but also the thoracic organs (Jacobs et al, ). Indeed, in the article immediately preceding the review relating to the inferior caval vein, in the same issue of the journal, another group of authors including two of those who collaborated with Spentzouris discussed the clinical significance of variations in tracheobronchial tree morphology (Wooten et al, ). These authors indicated that an isomeric arrangement of the bronchi is a key feature of so‐called heterotaxy, and rightly identified this feature as “a disorder of laterality.” Commenting on the correlation between abnormalities of the abdominal and thoracic organs, they suggested that left bronchial isomerism is found in three‐fifth of patients with “polysplenia syndrome,” and right bronchial isomerism in seven‐tenths of those with asplenia.…”

Section: Introductionmentioning

confidence: 99%

“…However, only the atrial appendages are uniformly isomeric (Uemura et al, 1995). It is therefore unfortunate that Wooton and colleagues described polysplenia as associated with “left atrial isomerism” (Wooten et al, ). They described the association between asplenia syndrome and isomerism of the right atrial appendages correctly.…”

Section: Introductionmentioning

confidence: 99%

The importance of being isomeric

et al. 2015

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In the normal individual, the parietal components of the body are mirror-imaged and appropriately described as isomeric. The thoraco-abdominal organs, in contrast, are lateralized. However, in "visceral heterotaxy," the thoraco-abdominal organs also show some degree of isomerism, best seen in the arrangement of the bronchial tree. Whether isomerism can be found within the heart remains controversial. One of two recent publications in this journal emphasized the crucial features of bronchial isomerism; the other, in contrast, confused the situation of isomerism within the heart. In this review, we show how the topic of cardiac isomerism is clarified by concentrating on the anatomical features of the cardiac components and determining how best they can be described. Appropriate manipulation of developing mice produces unequivocal evidence of isomerism of the atrial appendages, but with no evidence of ventricular isomerism. In hearts from patients with so-called "heterotaxy," only the atrial appendages, distinguished on the basis of the pectinate muscles lining their walls, are uniformly isomeric, permitting the syndrome to be differentiated into the subsets of left as opposed to right atrial appendage isomerism. Thus, controversies are defused by simply describing the isomerism of the atrial appendages rather than "atrial isomerism," recognizing the frequency of abnormal venoatrial connections in these settings. Any suggestion of ambiguity is removed by the equally simple expedient of describing all the variable cardiac features, describing the arrangements of the thoracic and abdominal organs separately should there be discordances.

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“…Numerous variations of lobar or segmental bronchial subdivisions have been described, but abnormal bronchi originating from the trachea or main bronchi remain rare conditions, with tracheal bronchus and ACB being the two most common tracheobronchial variants 1. ACB is an extremely rare condition (incidence 0.09–0.5%), usually asymptomatic and discovered incidentally 1.…”

mentioning

confidence: 99%

“…ACB is an extremely rare condition (incidence 0.09–0.5%), usually asymptomatic and discovered incidentally 1. ACBs are mostly blind, but can also lead to vestigial or ventilated parenchymal tissue, which must be searched for on CT scan.…”

mentioning

confidence: 99%