Experience of Two Cases of a Tracheal Bronchus Performed Surgery under Endotracheal Intubation

Abstract

The authors report two cases of a bronchial anomaly in which surgery was performed using differential lung ventilation. Both patients had a tracheal bronchus (TB), with the right upper lobe bronchus arising from the trachea. Case 1 involved a 57-year-old man who had a thymic cyst in the anterior mediastinum, and the right upper lobe apical bronchus branching independently from the trachea (TB). We planned resection of the cyst by video-assisted thoracic surgery (VATS) via the right thoracic cavity, however, decided against it, because the existence of the TB would preclude stable differential lung ventilation. We had not acknowledged that he had a TB before surgery. Ultimately, we could not avoid resection of the cyst via a midline sternotomy. Case 2 involved an 81-year-old woman who had cancer of the right upper lobe bronchus, which branched independently from the trachea (TB). We could perform right upper lobectomy by VATS nearly in the usual manner, although it was necessary to keep in mind that the TB branched out from a more proximal aspect of the trachea than usual. Preoperative grasp of the existence of TB and careful assumption for possible events such as ventilatory insufficiency are important.