Diagnosis of tracheal bronchus in children

Background: Tracheal bronchus is defined as an abnormal bronchus that comes directly off the lateral wall of the trachea above the carina and goes toward the upper-lobe territory. This congenital anomaly may be asymptomatic or present with such symptoms as stridor, cough, wheezing, persistent or recurrent upper-lobe pneumonia, atelectasis or air trapping. This retrospective study was undertaken to summarize the characteristics of tracheal bronchus in children. Methods: The clinical features of 7 patients with tracheal bronchus were retrospectively analyzed. Of these patients, 2 were initially diagnosed with tracheal bronchus by chest CT and later confirmed bronchoscopically, and 5 by bronchoscopic examination. Results: Tracheal bronchus was detected in 7 (1.8%) of the 396 patients receiving bronchoscopy. It occurred at the right lateral wall of the trachea in all the 7 patients. Four patients had retained secretions in the tracheal bronchus, which may result in the symptoms of cough, wheezing, and tracheal or bronchial obstruction. Three patients presented with symptoms irrelevant to tracheal bronchus: 1 patient was complicated by laryngomalacia and tetralogy of Fallot, 1 by tracheomalacia, tracheal stenosis and ventricular septal defects, and 1 had mucus plugs in the left lower bronchus. Conclusion: Tracheal bronchus is a common congenital anomaly in children receiving bronchoscopic examination. More than 50% patients have relevant symptoms. Bronchoscopy is definitely a diagnostic method for tracheal bronchus. World J Pediatr 2007;3(4):286-289