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PubMedDate not supplied

Computed tomography of the tracheal bronchus.

Tracheal bronchus is an uncommon anomaly in which an ectopic bronchus arises from the trachea above the carina. It occurs on the right side and two types are described: "supernumerary," which is associated with a normal trifurcating right upper lobe bronchus, and "displaced," in which instance the ectopic bronchus supplies the apical segment of the upper lobe. The CT appearance of this anomaly is described in two cases. Findings include identification of a bronchus arising from the trachea in a section more cephalad than the carina and the presence of only two segmental bronchi arising from the anatomic right upper lobe bronchus when the anomaly is of the "displaced" type. Thin axial sections and coronal imaging display the tracheal bronchus to best advantage.

Aged↗
PubMed1992

Small bronchogenic carcinomas presenting as solitary pulmonary nodules. Bioptic approach guided by CT-positive bronchus sign.

To evaluate the utility of the CT bronchus sign in making a choice between transbronchial biopsy (TBB) and transthoracic needle aspiration (TTNA) as the first diagnostic procedure in a patient with a solitary pulmonary nodule (SPN), we reviewed the results of TBB and TTNA in 26 patients who had a bronchogenic carcinoma less than 3 cm, studied with thin-section CT. The patients were divided into two groups. Group 1 included ten cases with a third- to fifth-order bronchus sign. Group 2 included two cases with a sixth-order bronchus sign and 14 cases with absence of a bronchus sign. TBB was performed in all the patients; conversely, TTNA was carried out in 22 patients. In group 1, TBB gave a diagnostic yield in eight (80 percent) of ten patients, while TTNA was positive in three (42 percent) of seven patients (p > 0.05). Conversely, in group 2, results of TBB were normal in all the patients, while TTNA gave a diagnosis in 10 (66 percent) of 15 patients (p < 0.05). We think that TBB should be considered the method of choice in diagnosing SPNs associated with a third- to fifth-order bronchus sign; conversely, TTNA is more useful than TBB in diagnosing SPNs in the presence of a more peripheral bronchus sign or with the absence of a bronchus sign. In conclusion, we suggest routine evaluation with thin-section CT of each SPN to optimize diagnostic management.

Biopsy, Needle↗
PubMed1995

CT of the bronchus intermedius: frequency and cause of a nodule in the posterior wall on normal scans.

OBJECTIVE: A focal nodule in the posterior wall of the bronchus intermedius is occasionally observed on normal CT scans. The purpose of this study was to determine the frequency and the anatomic cause of this finding. MATERIALS AND METHODS: We prospectively analyzed helical CT scans (10-mm collimation and 10-mm/sec table speed) for evaluating nodules in the posterior wall of the bronchus intermedius from 280 consecutive subjects. A focal round elevation in the posterior wall of the bronchus intermedius was considered a nodule. Frequency of visualization of the nodule was recorded. In patients showing such nodularity, additional enhanced CT scans with thinner slices (5-mm collimation and 5-mm/sec table speed) were obtained to elucidate the nature of the nodularity. RESULTS: Nodularity in the posterior wall of the bronchus intermedius was observed in 14/280 total subjects (5%) on 10-mm collimation CT scans. On thin-section CT scans, the nodularity was caused by a branch of the vein from the posterior segment of the right upper lobe (10/14, 71%) or by a branch of the vein from the superior segment of the right lower lobe (4/14, 29%). The vein from the upper lobe that caused nodularity in the posterior wall of the bronchus intermedius drained into either the inferior pulmonary vein (7/10) or the superior pulmonary vein (3/10). In all patients whose nodularity was caused by the vein from the superior segment of the right lower lobe, the vein drained into the inferior pulmonary vein. CONCLUSION: Focal nodularity in the posterior wall of the bronchus intermedius was caused by the draining pulmonary vein, and it was observed in 5% of normal subjects. This nodularity should be differentiated from uniform or lobular thickening associated with abnormality in the bronchus intermedius.

Adolescent↗
PubMed2003

Spasmogenic action of endothelin-1 on isolated equine pulmonary artery and bronchus.

REASONS FOR PERFORMING STUDY: There is currently little published information about the effects of endothelin-1 (ET-1), a potent endogenous spasmogen of vascular and airway smooth muscle, on pulmonary vasculature and airways or which ET receptor subtypes mediate ET-1-induced vasoconstrictive and bronchoconstrictive action in the horse. OBJECTIVES: To investigate the effect of endothelin-1 (ET-1) on smooth muscle from isolated equine pulmonary artery and bronchus. In addition, the roles of ETA and ETB receptors in ET-1 mediated contraction in these tissues were assessed. METHODS: The force generation of ring segments from pulmonary arteries or third-generation airways (obtained from horses subjected to euthanasia for orthopaedic reasons) were studied in an organ bath at 37 degrees C in response to exogenous endothelin and selective endothelin A (BQ123) or B receptor (BQ788) antagonists. RESULTS: ET-1 produced concentration-dependent contractions of the equine pulmonary artery and bronchus. The threshold for contraction was 10(-10) and 10(-9) mol/l ET-1 for pulmonary artery and bronchus, respectively. The maximal contraction induced by the highest ET-1 concentration (10(-7) mol/l) was 173 and 194% of the contraction obtained with 100 mmol/l KCl in pulmonary artery and bronchus, respectively. ET-1 potency was 25 times greater in equine pulmonary artery than in equine bronchus (concentration of ET-1 producing 50% of maximal contraction [EC50] = 5.6 10(-9) mol/l and 2.2 10(-8) mol/l, respectively). In pulmonary artery, ET-1 induced contractions were significantly inhibited by the ETA receptor antagonist BQ123 (1 micromol/l; dose-response curve to ET-1 was shifted to the right by 5.4-fold), but not by the ETB antagonist BQ788. In bronchus, dose-responses curves to ET-1 were shifted to the right by BQ123 (1 micromol/l; 2.5-fold), but not by BQ788 (1 micromol/l). In the presence of both antagonists, the dose-response curve to ET-1 was shifted to the right by 4.5-fold. CONCLUSIONS: These functional studies demonstrate that ET-1 is a potent spasmogen of equine third generation pulmonary artery and bronchus, and that contractions are mediated via ETA receptors in the former and both ETA and ETB receptors in the latter. POTENTIAL CLINICAL RELEVANCE: Endothelin receptor antagonists may have potential for treating equine pulmonary hypertension or bronchoconstriction.

Animals↗
PubMed2000

[Right tracheal bronchus with anomalous ramification of the bronchial artery disclosed during an episode of hemoptysis].

A 63-year-old woman was referred to our hospital on June 18th, 1998 during an episode of hemoptysis that had lasted for 6 days. She had no hemorrhagic diathesis and no history of pulmonary disease. Chest X-ray films disclosed a ground-glass opacity in the right upper lung field. Bronchoscopic examination revealed bleeding from an anomalous ectopic orifice on the right lateral trachea, about 1 cm above the carina. Chest computed tomographic examinations by conventional and spiral methods readily disclosed an ectopic bronchus. Bronchial arteriography showed that the tracheal bronchus was fed by a branched vessel of the thyrocervical artery arising from the brachiocephalic artery. Atypical mycobacterium was detected in bronchoalveolar lavage fluid from the ectopic bronchus. A shunt had formed with the pulmonary artery and peripheral parts of the bronchial artery that fed the tracheal bronchus. It was speculated that the hemoptysis in this case might be due to the combined phenomena of infection and abnormal vessel formation in the tracheal bronchus. In our patient, the system of blood supply to the tracheal bronchus may have been a manifestation of atavism because it closely resembled the circulatory structure of the tracheal bronchi normally observed in sheep and giraffes. The tracheal bronchus should be taken into consideration as a potential cause of hemoptysis, inflammatory changes, and atelectasis during intubation.

Bronchi↗
PubMed2001

Bridging bronchus in an infant demonstrated by direct coronal computed tomography and three-dimensional rendering display.

Bridging bronchus is a rare anomaly in which the right lower lobe bronchus arises from the left main bronchus and bridges the lower mediastinum. The first reported case was diagnosed at autopsy in 1976. The second reported case was diagnosed by bronchography confirmed at autopsy in 1980. We describe a 9-month-old infant with such an anomaly. Our patient presented with cough, shortness of breath, and rhinorrhea with no fever or sputum production. The physical examination revealed only coarse breath sound and chest retraction with no other abnormalities. Chest radiography showed decreased lung volume and shifting of the mediastinum to the left. Diagnosis of this anomaly was not possible with computed tomography (CT) axial imaging. Direct coronal CT and 3D rendering with the surface-shaded display technique showed a small right upper lobe bronchus and proximal stenotic left main bronchus, with the intermediate bronchus originating from the left main bronchus and crossing the midline to enter the contralateral lung.

Bronchi↗
PubMed1991

[Left lower sleeve lobectomy for tuberculous stenosis of left main bronchus--a case report].

A 35-year-old women complained exertional dyspnea during medication therapy for pulmonary tuberculosis. Thoracotomy was done under the diagnosis of stenosis of the left main bronchus and of obstruction of the left lower bronchus due to bronchial tuberculosis. The collapsed inferior lobe of the left lung with fibrotic change was resected. The left main bronchus was completely resected without only one cartilage ring nearest to the carina. The anastomosis of the left main bronchus end was performed to the end of the left lower lobe bronchus. This procedure of anastomosis is considered to be technically difficult for anatomical views, and its reports have been few. From our experience this operation can be performed safely by following modifications, 1) Botallo ligament was detached to obtain a wide operative filed for the end to end anastomosis of bronchus, 2) by taping of the trachea and the right main bronchus and applying traction by the tape, bronchial anastomosis was performed under direct view with great facility, and 3) omentopexy was added to prevent the suture insufficiency of the anastomosis.

Adult↗
PubMed1988

Reconsideration of the anatomy of sling left pulmonary artery: the association of one form with bridging bronchus and imperforate anus. Anatomic and diagnostic aspects.

In sling (retrotracheal) left pulmonary artery (SLPA), the tracheobronchial pattern is generally considered basically normal. Analysis of dissected specimens and/or bronchograms and other preparations from five studied and 32 reported patients suggests that there are two different forms of SLPA: (1) types 1A and B, with normal TB pattern [with (A) or without (B) a right pre-eparterial (tracheal bronchus)], and the aberrant left pulmonary artery causing TB compression. The tracheal bifurcation in type 1 SLPA is usually demonstrable at the fourth to fifth thoracic vertebral level; (2A) SLPA type 2A, with bridging bronchus (BB), in which condition the right main bronchus supplies the right upper lobe, but the bronchus supplying the right middle and lower lobes (the bridging bronchus) arises from the left main bronchus (LMB), posterior to which the SLPA courses; (2B) SLPA type 2B, with absence of the right bronchial tree, and the right lung (usually hypoplastic) supplied by a BB from the LMB, posterior to which the SLPA courses. SLPA types 2A and B have in common varying degrees of tracheal stenosis with abnormal cartilage rings and absent tracheal pars membranacea, abnormally low tracheal "bifurcation" (pseudocarina) at average level T6, increased bronchial angles with "inverted T" pattern, and lower level of anterior esophageal indentation by the SLPA than SLPA type 1. Imperforate anus occurred in 8/58 (14%) of patients with SLPA types 2A or B, but possibly in none with SLPA type 1. SLPA type 2 is the predominant form of SLPA, with the incidence of type 2B being twice that of type 2A.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMedDate not supplied

Tracheal bronchus.

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. Its incidence ranges between 0.1 and 5%. This anomaly usually is diagnosed incidentally during bronchoscopy or bronchography performed for various respiratory problems. Occasionally, it represents the underlying etiology for chronic pulmonary disease such as emphysema, atelectasis, and persistent or recurrent pneumonia, especially if it involves the right upper lobe and reflects an abnormal pulmonary clearing mechanism. Tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. In the absence of clinical symptoms, a diagnosis of tracheal bronchus does not require any treatment. In patients with recurrent right upper lobe disease and a tracheal bronchus, therapy should include resection of the aberrant bronchus as well as the lobe it supplies.

Bronchi↗
PubMed2001

Wedge resection of the bronchus: an alternative bronchoplastic technique for preservation of lung tissue.

OBJECTIVES: We present a modified wedge resection of the bronchus, as an alternative bronchoplastic technique for lung resection, in cases of patients with or without adequate pulmonary reserve to undergo a pneumonectomy, in order to preserve lung tissue. METHODS: Seventeen patients underwent a major lung resection with wedge resection of the bronchus for non-small cell lung cancer (NSCLC) in our department, from March 1995 to October 1999. A right-sided NSCLC were diagnosed in 17 males, with a mean age 62.5+/-6.6 (range 51-72) years. Further workup was free of metastatic disease. All patients underwent a right posterolateral thoracotomy, under general anesthesia with a double lumen endotracheal tube. Twelve right upper lobectomies, four right upper and middle lobectomies and one carinal resection were performed. The wedge resection of the bronchus carried out longitudinally, along the bronchial tree, and the bronchial defect was reapproximated transversely, in a single-layer, with interrupted non-absorbable suture. The frozen section of the distal margin of the resected bronchus was negative for malignancy in all patients. Extended mediastinal lymph node dissection followed each lung resection. RESULTS: The pathology report showed 12 squamous-cell carcinomas, three adenocarcinomas, one adenosquamous carcinoma and one neuroendocrine carcinoma. The differentiation of the carcinomas was well in two cases, moderate in ten and poor in five. The pTNM stage was IB in four patients (23.5%), IIA in one (5.9%), IIB in eight (47.1%) and IIIA in four (23.5%). The median disease-free distal margin of the bronchus was 5 mm (range 2-15 mm). The average postoperative hospital stay was 15 days (range 12-28 days). The morbidity and mortality rate was 11.8 and 5.9%, respectively. Postoperative follow-up was every 6 months. The average survival is 20.0+/-15.2 months (range 1-54 months). There are 12 patients alive, and their follow-up is negative for locoregional recurrence or distant metastasis. The survival study showed no significantly statistic relation to the histologic type, cancer differentiation, pTNM stage, and disease-free distal margin of resection larger or less than 0.5 cm (Kaplan-Meier study log rank method). CONCLUSIONS: The wedge resection of the bronchus as a bronchoplastic procedure is an easy, fast and safe technique of reparation of the bronchial tree. It presents not only a low rate of morbidity and mortality, but also a satisfactory survival.

Aged↗
PubMed2005

Frequency and potential cause of bronchus-associated lymphoid tissue in fetal lungs.

Bronchus-associated lymphoid tissue consists of lymphoid follicles with or without a germinal center within the bronchial wall. Bronchus-associated lymphoid tissue is part of the integrated mucosal immune system and present in about 50% of healthy infants. We examined a series of 141 fetal and neonatal lungs and detected bronchus-associated lymphoid tissue in 100% of cases with amniotic infection while postpartum perinatal pneumonia did not elicit bronchus-associated lymphoid tissue formation. Only rarely and in low density, bronchus-associated lymphoid tissue was present in non-infected fetuses. The in utero formation of bronchus-associated lymphoid tissue seems to be a reactive phenomenon and - as has been shown in another study - does not portend an adverse prognosis.

Autopsy↗
PubMed2006

Adjacent bronchus attenuates pulmonary arterial contractility.

Bronchus-derived relaxing factor (BrDRF) decreases contractility of newborn rat pulmonary arteries (PA) and is dependent on nitric oxide (NO) synthesis. In vivo, this factor appears to gain access via the adventitial side of the PA. However, the adventitia has been reported to be a barrier to NO. We studied the effect of an adjacent bronchus on PA contractility to norepinephrine in nine juvenile lambs in the presence and absence of inhibitors of the NO pathway (LNA, ODQ, and Rp-8-Br-PET-cGMPS), cytochrome P-450 inhibitor (17-ODYA), perivascular nerve activity blocker (TTX), and superoxide scavenger (tiron), and following disruption of bronchial epithelium. We also evaluated whether BrDRF was effective on both the endothelial and/or adventitial side of PA. Fifth-generation PA rings with and without an attached bronchus were contracted in standard baths with norepinephrine. PA were dissected, cut open, and placed in a sided chamber in which adventitial and endothelial sides of the PA were exposed to unattached bronchus separately. Norepinephrine (10(-8) to 10(-5) M) contractions were expressed as a fraction of maximal KCl (118 mM) contractions. Norepinephrine contractions were significantly reduced by the presence of an attached bronchus, an effect reversed by pretreatment with LNA, ODQ, and Rp-8-Br-PET-cGMPS, and removal of bronchial epithelium. Unattached bronchus in the bath perfusing the adventitial side was effective in inhibiting the contractile response in PA. NO gas relaxed PA when administered on the endothelial side only. We speculate that BrDRF is a diffusible factor that crosses the adventitia and stimulates production of NO within the PA.

Animals↗
PubMed1983

Parasympathetic and adrenergic contractile responses in canine trachea and bronchus.

We compared the sympathetic and parasympathetic contractile responses of tracheal and third-order bronchial smooth muscle simultaneously in 26 dogs in situ. Stimulus-response curves were generated by bilateral stimulation of the cervical vagus nerves in five dogs to determine the parameters (20 V, 15 Hz, 2-ms duration) causing maximal parasympathetic contraction in trachea and bronchus. In six adrenal-intact (ADi) and five adrenalectomized (ADx) dogs, sympathetically mediated alpha-adrenergic contraction was studied after muscarinic and beta-adrenergic blockade by administering intravenous (iv) 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP). In ADi dogs, the maximal alpha-adrenergic contractile response to iv DMPP was 67.3 +/- 14.8% of the maximal parasympathetic response in trachea and 112 +/- 21% of the maximal parasympathetic response in bronchus (P less than 0.03). In ADx dogs, the maximal alpha-adrenergic-to-parasympathetic stimulation ratios were 17.6 +/- 1.3% in trachea and 41.4 +/- 2.5% in bronchus (P less than 0.001). Comparable relationships were also obtained in pharmacological studies of alpha-adrenergic and cholinergic responses in trachea and bronchus. We conclude that there is substantial heterogeneity in the physiological and pharmacological cholinergic and alpha-adrenergic contractile properties in trachea and bronchus. Relative to cholinergic contraction, both circulating catecholamines and sympathetic innervation cause substantially greater alpha-adrenergic contraction in bronchus than for tracheal smooth muscle.

Adrenergic Fibers↗
PubMed1985

The anterior bronchus sign: a new clue to hilar abnormality.

One hundred normal posteroanterior chest radiographs were reviewed to determine the frequency of appearance and characteristics of the anterior segmental bronchi of the upper lobes. The bronchus was visible as a sharp circle on the right in 45% of normals, and on the left in 50%. In 90% of normals, there is less than 3 mm of tissue lateral to the bronchus. In 10% of normals, pulmonary vessels may cause 3-5 mm of tissue lateral to the bronchus. Four cases of bronchogenic carcinoma were found to have more than 5 mm of tissue lateral to the bronchus. The presence of more than 5 mm of tissue lateral to the anterior segmental bronchus is termed the "anterior bronchus sign" and is a helpful clue to recognizing hilar region abnormality.

Bronchi↗
PubMed1990

The anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph: CT correlative study.

We designed a study to determine whether thickening or effacement of the anterior wall stripe of the left lower lobe bronchus on the lateral chest radiograph implies adjacent disease, as it does for the posterior wall stripe of the right bronchus intermedius. The anterior wall stripe of the left lower lobe bronchus originates from the inferior anterior aspect of the end-on left bronchus and descends in a gentle posteriorly convex curve. The left lower lobe bronchus was identified on routine lateral chest films in 86 of 90 consecutive patients who also had chest CT. In those cases the anterior wall stripe was measured and categorized on chest films. On the CT scans, the length of the left lower lobe bronchus and its relationship to the left lower lobe artery and left upper lobe, lingular, and lower lobe veins were assessed. The presence of adjacent disease was noted. A complete anterior wall stripe was seen in 59 of 86 cases. It was effaced by anterior soft tissue in 15 of 86 cases; in 12 of 86 cases only the superior 0.5-1.5 cm was effaced. A normal anterior wall stripe was as thick as 12 mm in one case, but was 6 mm or less in 90%. Shapes other than linear were common. Anatomic variation accounted for nearly all of these findings. There was no focal abnormality in the 12 cases with partial effacement or in nine of the 15 cases with complete effacement; disease was significant in only two of these six. We concluded that thickening or effacement of the anterior wall stripe is an unreliable sign of disease.

Adenocarcinoma↗
PubMed2005

[Analysis of the association between double-lumen endobronchial tube and inner diameter of the left main bronchus].

OBJECTIVE: To investigate the association of the left double-lumen endobronchial tube (DLT) and the inner diameter of the left main bronchus. METHODS: Totally 100 adult patients who required intubation of a left-sided DLT during anesthesia for elective thoracic surgery were randomly enrolled in this study. All the participants underwent a preoperative chest CT scan by a spiral CT scanner. The diameters of the trachea and left main bronchus were measured with three-dimensional image reconstruction technique. All the measurements were performed using the electronic calipers of the spiral CT scanner and the left-sided DLT (Portex SIMS, USA) of the sizes 41Fr, 39Fr, 37Fr, and 35Fr were selected, being predicted according to the inner diameter of the left main bronchus. The placement of DLT was performed after anesthesia induction, and a DLT of a smaller size was selected if the bronchial end of the DLT failed to enter the left main bronchus after two attempts. The trachea and left main bronchus were examined for injury and other complications with postoperative fibreoptic bronchoscopy (FOB). RESULTS: All the 100 patients were intubated with DLT of appropriate sizes and satisfactory lung isolation was achieved. Postoperative complications of the trachea and bronchus were observed in none of the patients with FOB examination. The appropriate size of DLT is correlated with the left main bronchial diameter (correlation coefficient r=0.7346). CONCLUSION: Clinically, the size of DLT can be determined in accordance with the inner diameter of the left main bronchea.

Adult↗
PubMed1991

[A case of accessory cardiac bronchus with acute empyema treated by open drainage].

A 40-year-old man was admitted to the hospital because of acute empyema localized in the right lower posterior pleural space. The conservative treatment with antibiotics for one month failed to show any clinical improvement. Surgical intervention, therefore, was required. Broncho-fiberscopic and bronchographic findings prior to open drainage revealed a supernumerary bronchus with inflammatory sign on the right intermediate bronchus and a small sprig like bronchial fistula attached to the tip of the abnormal bronchus. The operation induced the swift alleviation of empyema and the disappearance of bronchial inflammation. From the location of empyema and the disappearance of bronchial inflammation associated with the improvement of clinical findings, the infection of the abnormal bronchus was thought as a main cause of empyema. Empyema caused by this kind of abnormality is extremely rare and no similar case has been reported in the literature to our knowledge. Some pathological problems of the abnormal bronchus were discussed and 54 cases of accessory cardiac bronchus reported in Japan were reviewed.

Acute Disease↗
PubMed1989

Clinical significance and measurement of the length of the right main bronchus.

It is important for surgeons, pathologists, anesthetists and anatomists to know the length of the right main bronchus. It extends from the carina of the trachea to the origin of the right upper lobe bronchus, but an exact method for measuring it has never been described. Using bronchography, the authors measured the length of the right main bronchus in 24 patients. The posteroanterior projection taken at a standard distance (1.8 m) from the patient was used to minimize distortion due to the technique; if present, the distortion would not be more than 5% and would be an increase rather than a decrease in length. The mean length of the right main bronchus was found to be 1.09 cm (range from 0 to 2.9 cm). The clinical importance of this measurement is discussed. The authors conclude that many anatomy textbooks err in describing the length of the right main bronchus as 2.0 to 5.0 cm, but are correct in describing the left main bronchus as being about 5 cm long.

Bronchi↗