Tracheal (accessory) bronchus – a case report

Abstract

Introduction: Tracheal bronchus (also known as accessory bronchus) is a congenital anatomical variant in which an additional bronchus originates directly from the supracarinal trachea. This type of anomaly usually arises about 2cm above the carina but can occur anywhere along the trachea, from the cricoid cartilage to the tracheal bifurcation.

Case Presentation: We present a case from our practice of a 62-year-old male, who arrived at our Multidisciplinary Emergency Department with complaints of sudden onset of dyspnea and high blood pressure with values of 225/125mmHg. The patient was admitted to the Clinic of Pulmonology and Phthisiology. He also reported having mild haemoptysis for the last 2 to 3 months. It was decided that a contrast-enhanced computed tomography scan with contrast enhansement should be performed, for the evaluation of possible pulmonary thromboembolism (PTE). As a result of the imaging study an accessory right bronchus was identified as an incidental finding.

Results: After excluding PTE as a possible diagnosis, the following changes were identified on the CT scan: accessory right bronchus located about 20mm from the carina; multilobulated retrotracheal gas structure (differential diagnosis - atypical accessory pulmonary segment; extraluminal mediastinal gas collections; tracheal diverticulosis); a perihilar tumour formation in the left lung, causing stenosis of the left main bronchus and its lobar branches; a combination of subsolid micronodules and ground glass opacities affecting most of the left lower lobe.

Conclusion: Tracheal bronchus is a congenital anomaly of the bronchial tree, often remaining entirely asymptomatic. Follow-up of such a finding should be done by an interdisciplinary team.