Congenital Anomalies of the Tracheobronchial Tree: A Meta-Analysis and Clinical Considerations

Ann Thorac Surg. 2021 Jul;112(1):315-325. doi: 10.1016/j.athoracsur.2020.08.060. Epub 2020 Nov 4.


Background: The aim of this study was to determine the prevalence and anatomic features of major tracheobronchial anomalies.

Methods: Major electronic databases were systematically searched to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcome was the prevalence of major tracheobronchial anomalies, specifically tracheal bronchus (TB) and accessory cardiac bronchus (ACB). Secondary outcomes included the origin and types of TB and ACB.

Results: A total of 27 studies (n = 119,695 patients) were included. A TB was present in 0.99% (95% confidence interval, 0.67 to 1.37) of patients, and an ACB was present in 0.14% (95% confidence interval, 0.09 to 0.20). The overall prevalence of TB was higher in imaging than in operative studies (1.81% vs 0.82%). It was also higher in pediatric (2.55%) than in adult studies (0.50%). Patients with other congenital anomalies were 15 times more likely to have a TB (odds ratio 14.89; 95% confidence interval, 7.09 to 31.22). The most common origin of TBs was from the trachea (81.42%), primarily from the right side (96.43%). The most common origin of ACBs was from the intermediate bronchus (74.32%). The ACBs terminated as blind-ending diverticulum in two thirds of cases.

Conclusions: Major tracheobronchial anomalies are present in approximately 1% of the population, although the prevalence is higher among pediatric patients and patients with accompanying congenital anomalies. Although rare, major tracheobronchial anomalies can be associated with significant respiratory morbidities and present challenges during airway management in surgical and critical care patients. Establishing a preoperative diagnosis of these variations is essential for planning and implementing an appropriate airway management strategy to minimize attendant complications.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Bronchi / abnormalities*
  • Bronchi / anatomy & histology
  • Child
  • Humans
  • Prevalence
  • Respiratory System Abnormalities / epidemiology
  • Trachea / abnormalities*