Challenging lung isolation secondary to aberrant tracheobronchial anatomy

Anesth Analg. 2011 Mar;112(3):688-92. doi: 10.1213/ANE.0b013e318206917a. Epub 2011 Feb 8.


Aberrant tracheobronchial anatomy is reported at an incidence of approximately 10% and most frequently involves the segmental and subsegmental bronchi. The most relevant abnormality to the practice of anesthesiology is the presence of a tracheal bronchus. Although typically an asymptomatic finding during bronchoscopy, a tracheal bronchus has important implications for airway management and lung isolation. Coexisting abnormalities may further complicate lung isolation. We describe a patient with a tracheal bronchus, coexisting with a left-shifted carina and apically retracted left mainstem bronchus, presenting for right extrapleural pneumonectomy. Attempts to place a left-sided double-lumen endotracheal tube were unsuccessful. We discuss our solution, review the literature, and present potential solutions for lung isolation in patients with a tracheal bronchus.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Airway Management / instrumentation
  • Airway Management / methods*
  • Bronchi / abnormalities*
  • Humans
  • Intubation, Intratracheal / instrumentation
  • Intubation, Intratracheal / methods*
  • Lung / physiology
  • Male
  • Trachea / abnormalities*