Coronal image from a chest CT shows a tracheal bronchus (arr | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Coronal image from a chest CT shows a tracheal bronchus (arrow). A tracheal bronchus is an anatomic variant where an accessory bronchus or displaced bronchus arises from the trachea. The tracheal bronchus almost always supplies the right upper lobe. Patients with a tracheal bronchus are usually asymptomatic but may present with recurrent right upper lobe pneumonia or recurrent right upper lobe atelectasis if intubated.

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Image description Coronal minimum intensity projection from chest CT shows both upper lobe bronchi (arrow) arising directly from the trachea in a patient with asplenia.

Teaching point A tracheal bronchus is a congenital airway anomaly in which a bronchus arises directly from the trachea and is almost always unilateral and right-sided. Bilateral tracheal bronchi are rare and are more commonly encountered in patients with heterotaxy syndromes. Asplenia is associated with right isomerism, which results in bilateral right-sided thoracic anatomy, including eparterial bronchi. In this setting, bilateral tracheal bronchi represent a manifestation of right isomerism. Recognition of a tracheal bronchus is important due to potential implications for recurrent pulmonary infections and airway management, particularly during intubation.

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This is the CT from my last upload. Patchy airspace opacification left lower lobe, tree-in-bud pattern in right upper lobe, and cavity opening into left upper lobe bronchus in left upper lobe. This is severe progressive primary #Tuberculosis. No enlarged nodes and no effusions.

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