scholarly journals Straight bronchial stent placement across the right upper lobe bronchus: A simple alternative for the management of airway obstruction around the carina and right main bronchus

2011 ◽  
Vol 141 (1) ◽  
pp. 303-305.e1 ◽  
Author(s):  
Yun-Hen Liu ◽  
Yi-Cheng Wu ◽  
Ming-Ju Hsieh ◽  
Po-Jen Ko
Keyword(s):  
Airway Obstruction ◽  
Stent Placement ◽  
Main Bronchus ◽  
Lobe Bronchus ◽  
Simple Alternative ◽  
Bronchial Stent ◽  
The Right

Cardiovascular-associated tracheobronchial obstruction in children

2012 ◽  
Vol 23 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Shen-Hao Lai ◽  
Sui-Ling Liao ◽  
Kin-Sun Wong
Keyword(s):  
Pulmonary Artery ◽  
Airway Obstruction ◽  
Main Bronchus ◽  
Main Pulmonary Artery ◽  
Diagnostic Tools ◽  
Radiographic Findings ◽  
Tracheal Compression ◽  
Airway Obstructions ◽  
Right Pulmonary Artery ◽  
The Right

AbstractTracheobronchial compression of cardiovascular origin is an uncommon and frequently unrecognised cause of respiratory distress in children. The compression may be due to encircling vessels or dilated neighbouring cardiovascular structures. Bronchoscopy and detailed radiography, especially computed tomography and magnetic resonance imaging, are among the most powerful diagnostic tools. Few previous reports have addressed the relationship between bronchoscopic findings and underlying cardiovascular anomalies. The objective of this study was to correlate bronchoscopic and radiographic findings in children with cardiovascular-associated airway obstruction. A total of 41 patients were recruited for the study. Patients with airway obstruction were stratified on the basis of the aetiology of the cardiovascular structures and haemodynamics into an anatomy-associated group and a haemodynamics-associated group. In the anatomy-associated group, stenosis and malacia were found with comparable frequency on bronchoscopy, and the airway obstructions were mostly found in the trachea (71% of patients). In the haemodynamics-associated group, malacia was the most common bronchoscopic finding (85% of patients), and nearly all locations of airway involvement were in the airway below the carina (90% of patients). The tracheal compression was usually caused by aberrant systemic branching arteries in the anatomy-associated group. In the haemodynamics-associated group, the causal relationships varied. Tracheal compression was often caused by lesions of the main pulmonary artery and aorta, whereas obstruction of the right main bronchus was caused by lesions of the main pulmonary artery and right pulmonary artery. The causes of left main bronchus compression were more diverse. In summary, the bronchoscopic presentations and locations are quite different between these two groups.

Tracheal Bronchus: Classification, Endoscopic Analysis, and Airway Management

2002 ◽  
Vol 126 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Andrew M. Doolittle ◽  
Eric A. Mair
Keyword(s):  
Congenital Anomaly ◽  
Airway Management ◽  
Main Bronchus ◽  
Case Series ◽  
Tracheal Bronchus ◽  
Lobe Bronchus ◽  
Retrospective Case ◽  
Tracheal Diverticulum ◽  
Pediatric Bronchoscopy ◽  
The Right

OBJECTIVE: Tracheal bronchus ( bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum. STUDY DESIGN/METHODS: Retrospective case series. RESULTS: The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12-year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right-sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy. CONCLUSIONS: Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options. Tracheal bronchus is a congenital anomaly in which a right upper lobe bronchus has its origin in the trachea rather than at the carina. Bronchus suis, or “pig bronchus,” is an alternate name that is used because a tracheal bronchus is normal in swine and other ruminant animals. In approximately 1000 pediatric bronchoscopy procedures performed by the senior author during a 12-year period, only 5 children (approximately 0.5%) were identified with a tracheal bronchus. We present 3 representative cases to highlight salient features of each variant of the tracheal bronchus. A newly described “tracheal diverticulum” variant is presented. Tracheal bronchus classification based on endoscopic analysis assists with airway management for this uncommon anomaly.

Tracheostenosis and Bronchial Abnormalities Associated with Pulmonary Artery Sling

1976 ◽  
Vol 85 (5) ◽  
pp. 582-590 ◽  
Author(s):  
Seymour R. Cohen ◽  
Benjamin H. Landing
Keyword(s):  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Main Bronchus ◽  
Left Pulmonary Artery ◽  
Surgical Correction ◽  
Left Main ◽  
Pulmonary Artery Sling ◽  
Lobe Bronchus ◽  
Normal Number ◽  
The Right

Three patients with aberrant left pulmonary artery (sling artery) are reported to illustrate associated tracheobronchial abnormalities. The clinical picture was that of severe episodic or progressive respiratory distress without dysphagia in early infancy. Striking narrowing of the trachea by complete “ring cartilages,” unrelated to compression by the abnormal pulmonary artery, was present. Tracheotomy and intubation failed to relieve the obstruction. In one patient the bronchi and bronchial segmentation pattern were normal, but in the other two patients, bronchial abnormalities included wide irregular cartilages in the main bronchi, forming more complete rings than is normal. In both, the right main bronchus was relatively longer than normal, and the bronchus intermedius showed poor cartilage ring formation and was relatively short compared to the main bronchus. This discrepancy did not appear to be due to distal displacement of the right upper lobe bronchus. In these two patients the left main bronchus was relatively short and wide with reduced number of cartilage rings (five-six vs usual normal number of nine), so that the right and left main bronchi were almost of equal length. However, the branch patterns of the lobar bronchi were within normal range. Bronchoscopy seems essential to demonstrate such ring tracheal cartilages (absence of the pars membranacea of the trachea), which when found should alert the examiner to the possible presence of an abnormal left pulmonary artery. Since surgical correction of tracheal stenosis of this type is not possible at present, the ultimate prognosis of patients with sling artery may depend more on the severity of the tracheal anomaly rather than on success of surgical correction of the abnormal left pulmonary arterial course. Although aberrant (sling) left pulmonary artery can occur in patients without respiratory tract symptoms, tracheal stenosis due to ring tracheal cartilages occurs in a significant fraction of patients with this arterial anomaly. Bronchoscopic study of the trachea, and possibly air or contrast bronchography of right and left main bronchi, can be of aid in diagnosis of this complex.

Video-assisted thoracoscopic parenchymal sparing “rotational” bronchoplasty for managing bronchial carcinoid tumor

2021 ◽  
Keyword(s):  
Carcinoid Tumor ◽  
Main Bronchus ◽  
Bronchial Carcinoid ◽  
Foreign Material ◽  
Clockwise Rotation ◽  
Lobe Bronchus ◽  
Video Tutorial ◽  
Bronchial Tumor ◽  
Free Closure ◽  
The Right

We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.

scholarly journals Isсhemic change in bronchus stump after lung cancer resection

2020 ◽  
Vol 179 (3) ◽  
pp. 33-39
Author(s):  
S. A. Plaksin ◽  
L. I. Farshatova ◽  
A. L. Lisichkin
Keyword(s):  
Main Bronchus ◽  
Lung Resection ◽  
Bronchopleural Fistula ◽  
Lower Lobe ◽  
Lobe Bronchus ◽  
Doppler Flowmetry ◽  
Bronchial Wall ◽  
Risk Patients ◽  
The Right ◽  
Right Lower Lobectomy

The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.

scholarly journals Endoscopic argon plasma coagulation for the management of solid, centrally located lung cancer

2007 ◽  
Vol 15 (3-4) ◽  
pp. 94-96 ◽  
Author(s):  
Bojan Zaric ◽  
Vukasin Canak ◽  
Aleksandar Milovancev ◽  
Goran Stojanovic ◽  
Gordana Balaban
Keyword(s):  
Lung Cancer ◽  
Airway Obstruction ◽  
Soft Tissues ◽  
Early Stage ◽  
Main Bronchus ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Early Stage Lung Cancer ◽  
Plasma Coagulation ◽  
The Right

Argon plasma coagulation (APC) is one of the interventional pulmonology techniques primarily aimed at the treatment of hemoptysis. It represents a form of non contact electrosurgey that uses ionized argon gas in order to produce electrical current that affects soft tissues. APC is reported to be effective in the treatment of early stage lung cancer, in the treatment of benign granulation tissue surrounding tracheal stents and in palliative treatment of malignant airway obstruction. Major indication for APC is hemostasis in severe hemoptysis, it can also be used as an alternative technique for laser resection or electrocautery, in urgent removal of tumors situated in large airways. The present article reports successful use of APC in the treatment of centrally located squamous cell lung cancer that caused complete right lung atelectasis. The use of APC led to complete reexpansion of the right lung and improvement in dyspnoea and chest discomfort of the patient. Significant improvement was observed in lung function parameters and blood gas analysis. With the use of APC solid tumor was completely removed from the right main bronchus and airway integrity was restored. From this case we can conclude that APC can be safely and successfully used for urgent debulking of malignant central airway obstruction.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

Deviated trachea in hypoplasia and aplasia of the right lung: Airway obstruction and its release by aortopexy

1990 ◽  
Vol 25 (3) ◽  
pp. 290-293 ◽  
Author(s):  
Christoph Döhlemann ◽  
Karl Mantel ◽  
Karl Schneider ◽  
Monika Güntner ◽  
Eckart Kreuzer ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
The Right

Tracheobronchial Compression in Acyanotic Congenital Heart Disease

1983 ◽  
Vol 92 (4) ◽  
pp. 387-390 ◽  
Author(s):  
Norman T. Berlinger ◽  
John Foker ◽  
Charles Long ◽  
Russell V. Lucas
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Main Bronchus ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Tracheobronchial Tree ◽  
Middle Lobe ◽  
Lobe Bronchus ◽  
Acyanotic Congenital Heart Disease

Children with acyanotic congenital heart disease frequently develop respiratory difficulties such as atelectasis, pneumonia, or infantile lobar emphysema. In some cases, the cause of the respiratory difficulty is compression of the tracheobronchial tree by hypertensive dilated pulmonary arteries, since this type of heart disease frequently demonstrates large left-to-right intracardiac shunts. Sites of predilection for compression include the left main bronchus, the left upper lobe bronchus, the junction of the right bronchus intermedius and right middle lobe bronchus, and the left side of the distal trachea. Cardiac anomalies which predispose to this type of compression include ventricular septal defect, patent ductus arteriosus, interruption of the aortic arch, and tetralogy of Fallot. Pulmonary arteriopexy may relieve the tracheobronchial compression.

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