July 2008.indd


SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 
JULY 2008, VOLUME 8, ISSUE 2, P. 231-232
SULTAN QABOOS UNIVERSITY©
SUBMITTED - 12TH NOVEMBER 2007
ACCEPTED - 3RD MARCH 2008

Tracheal Bronchus
*Anupam K Kakaria,1  Sukhpal Sawhney,1 Rajeev Jain2

THE PATIENT IS A YOUNG FEMALE WHO  presented at Sultan Qaboos University Hos-pital, Oman, with symmetrical joint pains, 
erythema nodosum and episcleritis. She was suspect-
ed to have sarcoidosis and a computed tomography 
(CT) chest scan was performed to look for mediastinal 
lymphadenopathy. The mediastinum showed evidence
of enlarged lymph nodes. Incidentally detected was a 
bronchus arising from the trachea a short distance be-
fore the carina. The tracheal bronchus is seen to arise
from the right posterior wall of the trachea [Figures 
1-3].

The tracheal bronchus maybe supernumerary if
the right upper lobe trifurcates and supplies the upper 
lobe normally and the accessory bronchus supplies 
an extra segment of right upper lobe. If the right up-
per lobe bronchus bifurcates into two, the accessory 
bronchus usually supplies the apical segment of the 
right upper lobe and it is a displaced bronchus.1 In our 
case, the right upper lobe bronchus shows a bifurca-
tion [Figure 3] suggesting this is a case of a displaced 
right apical bronchus. Figure 4 shows a virtual bron-
choscopic reconstruction.

The anomaly is a rare entity with a reported in-

يَّة الرُّغامِ
بَةُ صَ القَ

جني راجيف كاكاريا، سخبال سوهني،  انوبام

I N T E R E S T I N G  M E D I C A L  I M A G E

1Department of Radiology, Sultan Qaboos University Hospital, Sultan Qaboos University. Muscat, Sultanate of Oman; 2Department of Radiology, 
College of Medicine and Health Sciences, Sultan Qaboos University. Muscat, Sultanate of Oman

*To whom correspondence should be addressed. Email: bittanupam@yahoo.com

Figure 1 and 2: Images in mediastinal and lung windows of the computed tomography scan show an acces-
sory bronchus arising from the right posterior wall of the trachea (arrow on figure 1). Also noted are enlarged
lymphnodes 



A N U PA M  K  K A K A R I A ,   S U K H PA L  S AW H N E Y  A N D  R A J E E V  J A I N

232

cidence of 0.1-3%.² Most of the tracheal bronchi are 
asymptomatic; however, some children with tracheal 
bronchus may suffer from stridor, recurrent infections
and respiratory distress. In adults, this condition may 
be associated with difficulties in intubation and ven-
tilation during anaesthesia. Accidental intubation of 
the tracheal bronchus may lead to inadequate ventila-
tion of the rest of the lung. It may also cause overin-
flation of the lobe supplied by the tracheal bronchus
and pneumothorax.  Accidental occlusion of the tra-
cheal bronchus by the endotracheal tube can lead to 

atelectasis of the involved lobe. If patient is aware of 
this condition, the anaesthesiologist should be alerted 
prior to any elective surgery to allow precautions to 
be taken.

R E F E R E N C E S

1. Naim YA, Eduardo V, Lawrence AK, Edwin ET. Trache-
al Bronchus. Respir Care 2004; 9:1056-1058. 

2. Baris B, Ege T. Tracheal bronchus. N Engl J Med 2007; 
357:17.

Figure 3: The bifurcation of the right upper lobe
bronchus (arrow)

Figure 4: Virtual bronchoscopic reconstruction 
viewed from above shows carina (black arrow) and 
the accessory bronchus arising from the right poste-
rior wall (white arrow)