Bridging bronchus, type six, as a new rare case of a bronchial anomaly.

Ashraf El-Molla,Samir Bawazir,Rashed Al-Otaibi,Hussein Al-Qudaihy,Mohamed Daabiss

doi:10.1186/s40981-016-0070-5

Abstract

In 1976, Gonzales-Crussi et al. (Am. J. Dis. Child. 130:1015–18, 1976) introduced the first case of bridging bronchus as a rare bronchial branching anomaly; since then, only 14 worldwide cases was described. We suggest our case might be number 15 and could be the first case of type six of this bronchial anomaly. We present a case of a 10-month-old infant with bridging bronchus, congenital tracheal stenosis, and double outlet right ventricle who underwent major laparoscopic surgery for repair of gastrointestinal anomalies to raise awareness of this rare underdiagnosed congenital anomaly and a thorough discussion of the tracheobronchial anomalies and its clinical implications.

Highlights

Bridging bronchus (BB) is a rare congenital bronchial anomaly [1] that may be associated with a tracheal anomaly such as congenital tracheal stenosis (CTS) [2]
It has been stated that clinical differentiation is important because the patients with BB, as in our case, often show tracheal and left main bronchus (LMB) stenosis [6]
The fifth type of BB was described by Medina et al and Wills et al, where the trachea appeared as carrot shaped and from the distal pseudocarina localized at a lower thoracic vertebral level than the normal position of the carina; the BB arises from the left main bronchus and supplies the right lower and middle lung lobes

Summary

Background

Bridging bronchus (BB) is a rare congenital bronchial anomaly [1] that may be associated with a tracheal anomaly such as congenital tracheal stenosis (CTS) [2]. Case presentation Seven months ago, a 10-week-old male infant was scheduled for a pull-through surgery of the colon and intestine via combined laparoscopic and perineal surgery. At 2 weeks old, the baby underwent patch reconstruction of the aortic arch with pulmonary artery banding During this procedure, he experienced two attacks of intraoperative cardiac arrest due to severe hypoxia and respiratory acidosis. At the age of 10 months old while his weight was 4.8 kg, the infant had underwent a laparoscopic surgery for repair of the gastrointestinal anomalies; the baby was. His vital signs were within the limits. On completion of the whole procedure, the child was transferred back to NICU, trachea intubated on PSV with an uneventful postoperative course

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Conclusions