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Published on: June 23, 2023
Presence of tracheal bronchus in children undergoing flexible bronchoscopy
Isabelle Ruchonnet-Metrailler1, Rola Abou Taam2, Jacques de Blic3
1Unité de Pneumologie Pédiatrique, Département de Pédiatrie, Hôpitaux Universitaires de Genève, Geneva, Switzerland; Département de Pathologie et Immunologie, Faculté de Médecine, Université de Genève, Geneva, Switzerland.
Insights
Tracheal bronchus (TB) is a rare congenital lung malformation. This study found TB in 0.9% of pediatric patients, often incidentally, and frequently associated with other birth defects.
Area of Science:
- Pediatric Pulmonology
- Congenital Malformations
- Respiratory System Anatomy
Background:
- Tracheal bronchus (TB) is a rare congenital anomaly where a bronchus arises from the trachea.
- Previous studies on TB prevalence and diagnosis in children are limited by small patient cohorts.
- This study investigates TB in a large pediatric cohort to provide new insights into its prevalence, presentation, and associated conditions.
Purpose of the Study:
- To determine the prevalence of tracheal bronchus in a large pediatric cohort.
- To analyze the clinical presentation and diagnostic procedures for TB in children.
- To identify associated malformations and syndromic patterns in pediatric patients with TB.
Main Methods:
- Flexible bronchoscopy data from 5970 children with respiratory symptoms were reviewed.
- Anesthetic management, associated malformations, and tracheobronchial anomalies were analyzed.
- Prevalence and characteristics of tracheal bronchus were assessed in the selected cohort.
Main Results:
- Tracheal bronchus was identified in 0.9% (57/5970) of pediatric patients.
- TB was often an incidental finding without clear clinical relevance.
- Associated anomalies were present in 61.5% of cases, including syndromic associations (21%), cardiac malformations (19.2%), and tracheal stenosis (14%).
Conclusions:
- Tracheal bronchus is a rare congenital anomaly of the tracheobronchial tree.
- It is frequently associated with other congenital defects, including cardiac and tracheobronchial malformations, or syndromic patterns.
- A direct link between respiratory symptoms and TB is uncommon, necessitating selective treatment approaches.
Background And Objectives:
Tracheal bronchus (TB) is a rare congenital malformation of the lung tree with a bronchus originating from the trachea. Only a small number of publications have analyzed the frequency and diagnostic procedure of TB in children, based on a restricted sample of patients. In the present study, we analyze and discuss new aspects of prevalence, clinical presentation and associated malformations of TB based on a large pediatric cohort.
Methods:
Data from 5970 children having a flexible bronchoscopy for investigation of respiratory symptoms were selected. We analyzed the anaesthesic management, the presence of associated malformations, and all tracheobronchial anomalies observed during the endoscopic procedure.
Results:
Fifty-seven cases of tracheal bronchus were identified (0.9%). In the majority of them, tracheal bronchus was a fortuitous discovery without clear clinical relevance. Statistical analysis revealed that the majority of TB originated from the middle and lower one third of the trachea (56%). 61.5% of patients had associated anomalies such as syndromic association (21%), cardiac malformations (19.2%) or tracheal stenosis (14%). Only 38.5% of children had no associated anomalies.
Conclusions:
Tracheal bronchus is a rare morphological anomaly of the tracheobronchial tree. Most often TB is associated with other birth defects such as another tracheo-bronchial tree malformation, vascular abnormality, congenital heart malformation or in the context of a syndromic pattern. A relationship between respiratory symptoms and the presence of TB is very rare and selective treatment is infrequent.
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