Lung isolation on a patient with a tracheal bronchus: Advanced airway management

Tracheal bronchus is a rare anatomical variant (prevalence ∼1%) that complicates lung isolation during thoracic surgery. We present an airway management approach using a double-lumen tube with an integrated camera (VivaSight DL) in a patient with this anomaly, highlighting the importance of preoperative imaging and device selection.

A 46-year-old male with an incidental tracheal bronchus underwent left upper lobectomy. Preoperative assessment included virtual bronchoscopy, computed tomography (CT) with 3D reconstruction and flexible bronchoscopy, confirming the aberrant bronchus originating 2 cm above the carina. A 37Fr left-sided video double-lumen tube was inserted under real-time guidance using its integrated camera, with tracheal bronchus patency confirmed by flexible bronchoscopy through the tracheal lumen. One-lung ventilation was achieved without complications.

In tracheal bronchus cases, preoperative CT with 3D reconstruction and bronchoscopy are critical for airway planning. Using a double-lumen tube with an integrated camera facilitates safe lung isolation by allowing real-time visual confirmation of anatomy and cuff positioning.