Implications of endotracheal tube placement in a patient with a true tracheal bronchus

We report a rare anatomic abnormality, a true tracheal bronchus, where the right upper bronchus originates directly from the supracarinal trachea. This unusual anatomic variant can be problematic for the anesthesiologist if it is unrecognized. It can lead to hypoventilation of the right upper bronchus or cause confusion in placement of a double-lumen endotracheal tube if the carina is misidentified, as demonstrated in our case report. Successful isolation of the right lung requires understanding and rapid recognition of the anomaly.