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Tracheal bronchus: association with respiratory morbidity in childhood
Insights
A rare tracheal bronchus, an abnormal airway, can cause recurrent pneumonia in children. Surgical resection is recommended if bronchiectasis or stenosis is present, especially in those with Down syndrome or rib abnormalities.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Genetics
Background:
- Tracheal bronchus, an aberrant right upper lobe bronchus arising from the trachea, is often considered incidental.
- It can be associated with recurrent respiratory symptoms in children, including pneumonia and stridor.
- Prevalence in children undergoing bronchoscopy for respiratory issues is approximately 2%.
Purpose of the Study:
- To determine the clinical significance of tracheal bronchus in pediatric patients.
- To identify associated congenital abnormalities and clinical presentations.
- To evaluate the efficacy of surgical intervention for associated complications.
Main Methods:
- Retrospective review of 18 pediatric patients with tracheal bronchus.
- Analysis of clinical presentation, associated anomalies, and diagnostic findings.
- Correlation of surgical outcomes with pre-operative diagnosis and intervention.
Main Results:
- Patients presented with recurrent pneumonia (n=9), stridor (n=6), respiratory distress (n=2), or thoracic mass (n=1).
- Congenital abnormalities were common (14/18), including Down syndrome and rib anomalies.
- Five patients with recurrent RUL pneumonia underwent RUL resection, with resolution of symptoms; 4/5 had bronchiectasis or stenosis.
Conclusions:
- Tracheal bronchus is clinically significant in children with recurrent RUL pneumonia, particularly those with Down syndrome or rib abnormalities.
- Bronchiectasis or bronchial stenosis associated with tracheal bronchus warrants consideration for surgical resection.
- Surgical resection of the affected lobe can resolve recurrent pneumonias in select pediatric cases.
Abstract:
An aberrant right upper lobe (RUL) bronchus arising from the trachea (tracheal bronchus) can be responsible for recurrent pneumonia. In this hospital, 2% of children requiring bronchoscopy for respiratory symptoms are found to have a tracheal bronchus, which is frequently thought to be an incidental finding. We reviewed findings in 18 patients to determine when a tracheal bronchus is of clinical significance. The age at presentation ranged from 1 day to 54 months (mean 17 months). The children had recurrent pneumonia (nine), stridor (six), respiratory distress (two) and a thoracic mass (one). Other congenital abnormalities were present in 14, including Down syndrome (two), tracheoesophageal fistula (two), and fused or hypoplastic first and second ribs (four). Recurrent RUL pneumonia was present in five. Bronchiectasis or bronchial stenosis was shown by bronchography in four of five; in all five the right upper lobe was surgically resected, with resolution of the recurrent pneumonias. The presence of a clinically significant tracheal bronchus should be considered in every child with recurrent RUL pneumonia, especially in children with Down syndrome or rib abnormalities; if bronchiectasis or bronchial stenosis is found, surgical resection should be performed.