1) It was described by Sandifort in 1975 as a right
upper bronchus originating in the trachea.
2) The term tracheal bronchus includes a variety of
bronchial anomalies arising in the trachea or main bronchus
and directed toward the upper-lobe territory.
3) This anomalous bronchus usually exits the right lateral
wall of the trachea less than 2 cm above the major carina
and can supply the entire upper lobe or its apical segment.
4) Tracheal bronchi occur almost exclusively on the
right trachea and are associated with other congenital
anomalies, particularly trisomy 21.
5) The defect in embryogenesis that results in this
disorder is uncertain. Possible mechanisms include abnormalities
in migration, selection, or reduction of airways during
6) In the embryonic stage, the respiratory system begins
its development in the third week of gestation, and
the main branches of the tracheobronchial tree down
to the terminal bronchiol are completed at 16 weeks
of intrauterine life.
7) Tracheobronchial anomalies (TBA) originate, during
this period, mainly at the level of the right main bronchus.
1) Tracheal bronchus is a common airway malformation,
with an incidence of 0.1 to 5 percent.
2) The development of pediatric bronchoscopy in the
last several years has allowed us to estabilish a better
diagnosis of these anomalies.
3) Those incidence varies from 1-3% of total bronchoscopies.
Andrew etc. illustrate 3 types of tracheal bronchi:
1) vestigeal tracheal diverticulum (newly described),
2) high apical lobe, and 3) fully developed supranumeray
aerated tracheal bronchus.
(Otolaryngol Head Neck Surg. 2002 Mar; 126(3):240-3.)
4. Clinical manifestations
1) Tracheal bronchus may be asymptomatic or the cause
of recurrent infections due to retained secretions.
2) Strido, recurrent pneumonia, and suspected foreign
body aspiration are commen presenting complaints in
children ultimately diagnosed with tracheal bronchus.
1) The diagnosis can be made with rigid and flexible
bronchoscopy or with image studies.
2) Direct bronchoscopy provides a clear definitive view
of the anomaly.
3) Flexible bronchoscopy is useful to document the presence
of segmental bronchi within the tracheal broncus.
1) Treatment is based on the severity of the symptoms.
2) Most patients with tracheal bronchus can be treated
3) In the case of recurrent respiratory infections,
the treatment of choice is resection of the anomalous
lobe and bronchus.
1) Tracheal bronchus should be included in the differential
diagnosis of any child who presents with recurrent right
lobe pneumonia or collapse, particularly in children
with other congenital deformities.
2) Bronchoscopy with selected radiographic imaging allows
to fully evaluate the child with a tracheal bronchus