Death of a 6-Month-Old Due to a Tracheal Bronchus

Abstract

The death of an infant younger than 1 year requires a thorough scene investigation and autopsy. Most infant deaths investigated by forensic pathologists can be placed into 2 general categories: sudden infant death syndrome and accidental asphyxial deaths. Despite the fact that most infant deaths occur within these 2 categories, it is important to remember that other entities may be responsible for death. In this report, we present a developmental pulmonary abnormality that was ultimately responsible for the death of an infant. A 6-month-old male infant with a prior history of pneumonia was brought to an emergency department for evaluation of fever. Antibiotics were prescribed, and the child was discharged and sent home with instructions to his mother to follow up with his pediatrician. Later that evening, the infant seemed to be in respiratory distress. His mother again transported him to the emergency department, where, on arrival, he became apneic. Despite vigorous resuscitative efforts, the infant died. Of note at autopsy was the presence of low-set abnormal ears and bilateral inward-turning ankles. Internally, an abnormality of the tracheobronchial tree was evident, with the right upper lobe bronchus arising from the distal trachea, proximal to the carina. In addition, the right upper lobe was discolored and firm. Microscopically, pneumonia was present. The cause of death was pneumonia due to a right tracheal bronchus. Childhood pneumonia is a known cause of childhood hospitalization, morbidity, and mortality. Identifying the causes of recurrent pneumonia, be it structural, metabolic, or syndromic, aids in preventing recurrent infections and reducing the incidence of childhood mortality. A tracheal bronchus, also known as bronchus suis or "pig bronchus," is an anatomic variant of the tracheobronchial tree in which a bronchus arises proximal to the carina, most commonly on the right and predominantly in males. The incidence is around 0.2%. Although the tracheal bronchus is sometimes a clinically silent entity, some patients may exhibit certain signs and symptoms, including hemoptysis, coughing, stridor, wheezing, and pain. The typical consequences of the tracheal bronchus are recurrent pneumonias. The recurrent pneumonia is thought to be due to a stasis of secretions and an abnormal pulmonary clearing mechanism. Treatment for the condition varies, based on symptoms. For asymptomatic patients, conservative management is adequate. For symptomatic patients with persistent atelectasis or right upper lobe consolidation, surgical excision is advised.