A rare anaesthetic challenge in a one-lung ventilated paediatric patient withright upper lobe tracheal bronchus

摘要

A tracheal bronchus is a rare congenital anomaly, suggesting abnormal bronchialdevelopment. The prevalence of tracheal bronchus in children who undergo bronchoscopy isestimated to be between 0.2% and 3%. When associated with recurrent infection, lobes ofthe lung must be removed to avoid further lung injury. In such cases, perioperativeone-lung ventilation and airway management remain a huge challenge for anaesthesiologists.The case of this rare airway anatomic abnormality in a paediatric patient with twobronchial openings into the right upper lobe, and with a history of recurrent pneumonia,is reported. In addition to a normal opening, a distinct opening in the upper lobe of theright lung was observed, that originated directly from the trachea, superior to thecarina. The entire right lung was deflated by left-lung ventilation using a single lumentracheal tube, and the patient underwent right upper lobe resection. No anaesthesiacomplications were observed during recovery. In this case, timely identification of thetracheal bronchus and successful collapse of the right lung were key points in theanaesthesia management of this patient.