Asplenia Syndrome With Bilateral Tracheal Bronchi
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.
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.