[Discordance in the anatomy of the bronchial tree and atrial appendages]

It is well known, that in complex congenital heart disease, the bronchial anatomy reflects the atrial situs in the majority of patients. Few exceptions to this rule have been reported in the literature. We report four patients in whom we found discordance between the anatomy of the bronchial tree and the external aspect of the atrial appendages. Two patients had bronchial situs solitus with atrial levoisomerism, the third patient had bronchial levoisomerism with atrial situs solitus and in the fourth one we found inverted bronchial anatomy with levoisomerism of the atrial appendages. In three patients, broncho-atrial discordance was diagnosed clinically by bronchial tomography and selective atrial angiography, and in the other one the diagnosis was made by anatomical study. In this last patient, external atrial anatomy was found to be of levoisomerism, with an internal atrial aspect of situs inversus. Prediction of atrial arrangement by bronchial anatomy retains its diagnostic value. However, it is necessary to bear in mind that exceptions do exist. It is discussed how to suspect these exceptions, and the final diagnostic conduct is indicated.