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; Anteroposterior chest radiographs. Atelectasis was seen in the left lower lobe (red circle) just after tracheal intubation (A), which showed improvement at the end of the 2-hour operation (B). No atelectasis was observed on the next day (C).
Reina Hayashi,
Shigeru Maeda,
Taninishi Hideki,
Hitoshi Higuchi, and
Takuya Miyawaki
Tracheal Bronchus Detected During General Anesthesia: A Case Report
Toru YamamotoDDS, PhD,
Tatsuru TsurumakiDDS, PhD,
Hiroko KanemaruDDS, PhD, and
Kenji SeoDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
DOI: 10.2344/anpr-70-02-09
Page Range: 173 – 177

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to the normal bifurcation at the carina. The main clinical implication of a tracheal bronchus arises during endotracheal intubation. 1 An endotracheal tube (ETT) can obstruct or migrate into a tracheal bronchus, causing pulmonary atelectasis and/or hypoxia. 2 – 5 We herein report a case of a tracheal bronchus that was incidentally found after induction of general anesthesia and discuss the

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Figure 1.; A portable chest radiograph taken at the postoperative care unit showing inadvertent placement of the endotracheal tube into the right bronchus (arrow). Complete atelectasis of the left lung is seen.
Bryant Cornelius and
Tetsuro Sakai
Figure 1.
Figure 1.

A portable chest radiograph taken at the postoperative care unit showing inadvertent placement of the endotracheal tube into the right bronchus (arrow). Complete atelectasis of the left lung is seen.

Figure 4. ; (A) Axial slice of the computed tomography scan showing the radiopaque enteric tube positioned in the right bronchus and looping into the posterior pleural space (arrow). (B) Sagittal slice of the same computed tomography scan with a lung filter demonstrating the enteric tube lying in the posterior pleural space with surrounding lung field atelectasis and effusion (arrow).
David B. Guthrie,
James P. Pezzollo,
David K. Lam, and
Ralph H. Epstein
Figure 4. 
Figure 4. 

(A) Axial slice of the computed tomography scan showing the radiopaque enteric tube positioned in the right bronchus and looping into the posterior pleural space (arrow). (B) Sagittal slice of the same computed tomography scan with a lung filter demonstrating the enteric tube lying in the posterior pleural space with surrounding lung field atelectasis and effusion (arrow).

Figure 2.; Tracheal Bronchus A, Fiberoptic view of the anomalous bronchus in the present case. Note that the orifice of the tracheal bronchus is positioned immediately to the right of the right main bronchus. B, Drawing of the bronchial anatomy showing the right upper lobe tracheal bronchus. • indicates carina; ▲, tracheal bronchus orifice.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 2.
Figure 2.

Tracheal Bronchus

A, Fiberoptic view of the anomalous bronchus in the present case. Note that the orifice of the tracheal bronchus is positioned immediately to the right of the right main bronchus. B, Drawing of the bronchial anatomy showing the right upper lobe tracheal bronchus. • indicates carina; ▲, tracheal bronchus orifice.

Figure 4.; Schematic Representing the 3 Types of Tracheal Bronchus Likely to be of Significance to Anesthesiologists Type I, displaced right upper lobe tracheal bronchus. Type II, supernumerary right upper lobe tracheal bronchus. Type III (this case), displaced right upper lobe tracheal bronchus as tracheal trifurcation.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 4.
Figure 4.

Schematic Representing the 3 Types of Tracheal Bronchus Likely to be of Significance to Anesthesiologists

Type I, displaced right upper lobe tracheal bronchus. Type II, supernumerary right upper lobe tracheal bronchus. Type III (this case), displaced right upper lobe tracheal bronchus as tracheal trifurcation.

Figure 3.; Portable AP Chest Radiograph Taken in OR After Intubation Note that the right upper lobe begins directly from the trachea and that the tube tip is located above all 3 apertures (red outline). AP indicates anterior-posterior; OR, operating room.
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 3.
Figure 3.

Portable AP Chest Radiograph Taken in OR After Intubation

Note that the right upper lobe begins directly from the trachea and that the tube tip is located above all 3 apertures (red outline). AP indicates anterior-posterior; OR, operating room.

Figure 1.; Preoperative Anterior-Posterior Chest Radiograph
Toru Yamamoto,
Tatsuru Tsurumaki,
Hiroko Kanemaru, and
Kenji Seo
Figure 1.
Figure 1.

Preoperative Anterior-Posterior Chest Radiograph

Pulmonary Aspiration During Induction of General Anesthesia
Reina HayashiDDS,
Shigeru MaedaDDS, PhD,
Taninishi HidekiMD, PhD,
Hitoshi HiguchiDDS, PhD, and
Takuya MiyawakiDDS, PhD
Article Category: Case Report
Volume/Issue: Volume 67: Issue 4
Online Publication Date: Dec 31, 2020
DOI: 10.2344/anpr-67-02-03
Page Range: 214 – 218

-optic bronchoscopy was performed by an anesthesiologist, revealing aspiration of clear fluids (∼20 mL) into multiple bronchi, which were evacuated as completely as possible. Lung recruitment maneuvers were performed, and an AP chest film was obtained that showed atelectasis in the left lower lobe ( Figure A). Elevated peak airway pressures of 28 cm H 2 O were noted, at a tidal volume of 500 mL, a positive end-expiratory pressure (PEEP) of 5 cm H 2 O, and a respiratory rate of 10 breaths/min. The results of an arterial blood gas analysis obtained from an arterial line that was

Inadvertent Endobronchial Intubation in a Patient With a Short Neck Length
Bryant CorneliusDDS, MBA, MPH and
Tetsuro SakaiMD, PhD
Article Category: Other
Volume/Issue: Volume 62: Issue 2
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.1.66
Page Range: 66 – 70

the patient was resedated with propofol and transferred to the postanesthesia care unit, where he was kept on a ventilator. A portable chest radiograph in the postanesthesia care unit revealed a right bronchial intubation and complete atelectasis of the left lung ( Figure 1 ). The endotracheal tube was adjusted and resecured at 19 cm at the incisors. A repeated chest radiograph showed the endotracheal tube terminating just above the level of the carina. Interval re-expansion of the left lung was observed, although there was persistent lower left lobe