An Accessory Cardiac Bronchus Was Identified During Double-Lumen Tube Position Verification with Flexible Bronchoscopy

Abstract

Accessory cardiac bronchus is a rare and poorly recognized congenital bronchial abnormality, with an incidence ranging from 0.07 to 0.5%.1Mehta AC Thaniyavarn T Ghobrial M et al.Common congenital anomalies of the central airways in adults.Chest. 2015; 148: 274-287Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The accessory cardiac bronchus arises from the inner wall of the right main bronchus or intermediate bronchus opposite to the origin of the right upper lobe bronchus. It can present with a blind end and no associated lung tissue, as well as with distal terminal branches ventilating a small lobule.1Mehta AC Thaniyavarn T Ghobrial M et al.Common congenital anomalies of the central airways in adults.Chest. 2015; 148: 274-287Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar,2Desir A Ghaye B. Congenital abnormalities of intrathoracic airways.Radiol Clin North Am. 2009; 47: 203-225Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar The accessory cardiac bronchus rarely causes symptoms or signs and usually is diagnosed as an incidental finding when the patient undergoes computed tomography scan or bronchoscopy for another purpose. However, owing to infection in pooled up secretions in a blind diverticulum of accessory cardiac bronchus, patient may present with recurrent infection, atelectasis, and hemoptysis.3Dogra N Singla K Kajal K et al.Unusual "cardiac" cause of hemoptysis: Accessory cardiac bronchus.Ann Card Anaesth. 2021; 24: 419-421PubMed Google Scholar Flexible bronchoscopy commonly is used for the confirmation of accurate double lumen tube positioning. We incidentally identified an accessory cardiac bronchus anomaly during flexible bronchoscopy examination after double lumen tube placement in a patient undergoing left lung lobectomy (Fig 1A). It arises from the inner wall of the intermediate bronchus opposite to the origin of the right upper lobe bronchus. Both axial and reconstructed coronal views of chest computed tomography suggested that accessory cardiac bronchus arises from the medial wall of the intermediate bronchus (Fig 1B, red arrow). Moreover, the coronal view of the computed tomography scan showed that the accessory cardiac bronchus was a short blind diverticulum with no associated lung tissue. None.