Bilateral tracheal bronchi in a patient with right isomerism

Published:November 23, 2021DOI:https://doi.org/10.1016/j.jcct.2021.11.010
      A 2-year-old boy underwent computed tomography angiography (CTA) for evaluation of complex congenital heart disease. CTA demonstrated a transverse midline liver with asplenia and the gastric fundus on the right side (Fig. 1A). Both atrial appendages were broad and triangular with a wide junction with the venous component of the atria, resembling a morphologically right atrial appendage (appendages of right-sided and left-sided atrium indicated by white and yellow asterisk respectively in Fig. 1B–C). All pulmonary veins (white arrows in Fig. 1D) were seen draining into the right sided atrium with presence of a large atrial septal defect. Other findings included a double-outlet right ventricle, ventricular septal defect and valvular pulmonary stenosis.
      Fig. 1
      Fig. 1Axial CT angiography image (A) shows a transverse midline liver with asplenia and the gastric fundus on the right side. Volume rendered images (B, right lateral view, and C, left lateral view) reveal appendages of the right sided atrium (white asterisk in B) and left sided atrium (yellow asterisk in C) to be broad and triangular with a wide junction with the venous component of the respective atrium. Volume rendered image (D, posterior view) demonstrates all pulmonary veins (white arrows) draining into the right sided atrium. Coronal minimum intensity projection image (E) and volume rendered image (F) depicts presence of bilateral tracheal bronchi (black arrows in E and yellow arrows in F), arising from the lateral tracheal wall, 6.3 mm and 4.9 mm proximal to carina respectively. Both, right and left, main bronchi resemble the morphologically right bronchus. 

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      References

        • Cope R.
        • Campbell J.R.
        • Wall M.
        Bilateral tracheal bronchi.
        J Pediatr Surg. 1986 May; 21: 443-444
        • Machovec K.A.
        • Greene N.H.
        • Raynor E.M.
        • Taicher B.M.
        Bilateral upper lobe bronchi originating from the trachea.
        Anesthesiology. 2017 Dec; 127: 1015