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Circulation. 2008;118:196-197
doi: 10.1161/CIRCULATIONAHA.107.763458
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(Circulation. 2008;118:196-197.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Asplenia Syndrome With Bilateral Tracheal Bronchi

Zhu Ming, MD; Shao Hong, MD; Jin Biao, MD

From the Shanghai Children’s Medical Center, Shanghai, China.

Correspondence to Zhu Ming, MD, Shanghai Children’s Medical Center, 1678 Dongfang Rd, Shanghai 200127, China. E-mail zhuming58{at}vip.sina.com

From July 2005 to December 2007, 21 consecutive children with asplenia syndrome underwent 16-row multidetector computed tomography (MDCT) examination. Minimum-intensity projection reconstruction was performed to show tracheobronchial tree in every case using a workstation. Among the 21 patients with asplenia syndrome, 16 had bilateral right-side bronchi and 5 (24%) had bilateral tracheal bronchi (Figure). All patients with bilateral tracheal bronchi received surgery, during which the imaging findings were confirmed.


Figure 1190078
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  		Figure. Asplenia syndrome with bilateral tracheal bronchi, A, Six-month-old girl. The reconstructed MDCT image shows bilateral tracheal bronchi and diaphragmatic hernia. B, Four-year-old boy. The reconstructed MDCT image shows bilateral tracheal bronchi, left upper lobe emphysema, and right upper lobe atelectasis. C, Five-month-old girl. The reconstructed MDCT image shows bilateral tracheal bronchi and left upper lobe emphysema. D, Three-year-old boy. The reconstructed MDCT image shows bilateral tracheal bronchi.

Tracheal bronchus was first described in 1785 as an airway malformation of the right upper bronchus originating in the trachea. The tracheal bronchus usually exits the right lateral wall of the trachea and can supply the entire upper lobe or its apical segment.1 The possibility of this diagnosis should be considered early in the clinical course of intubated patients. The condition could be complicated in children by persistent right upper lobe atelectasis if the presence of a tracheal bronchus was not recognized initially.2

Patients with asplenia syndrome lack a spleen, and they typically have a bilateral right-sided tendency. Bronchi of both sides can be considered right-side bronchi in patients with asplenia syndrome.3 Thus, the bilateral tracheal bronchi can be considered bilateral right bronchi.


*    Disclosures
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None.


*    References
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 up arrowDisclosures
 *References
 
1. Berrocal T, Madrid C, Novo S, Gutierrez J, Arjonilla A, Gomez-Leon N. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics. 2004; 24: e17. Abstract.[Abstract/Free Full Text]

2. O’Sullivan BP, Frassica JJ, Rayder SM. Tracheal bronchus: a cause of prolonged atelectasis in intubated children. Chest. 1998; 113: 537–540.[CrossRef][Medline] [Order article via Infotrieve]

3. Deanfield JE, Leanage R, Stroobant J, Chrispin AR, Taylor JF, Macartney FJ. Use of high kilovoltage filtered beam radiography for detection of bronchial situs in infants and young children. Br Heart J. 1980; 44: 577–583.[Abstract/Free Full Text]





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