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A 25-year-old male complaining of fever and cough was admitted to our hospital.Bronchofiberscopy revealed a polypoid tumor nearly obstructing the right main bronchus. Biopsy of the tumor proved it to be a bronchial carcinoid. Endoscopic Nd-YAG laser treatment was done to identify the base of the polyp and the extent of tumor involvement before operation. After the laser delivery of 13276 Joules in three times the obstruction was relieved. To preserve pulmonary function, a bronchoplastic procedure was performed as follows : the truncus intermedius was cut just above the middle lobe bronchus, then the right main bronchus was cut below the upper lobe bronchus to remove the tumor. The resected edge proved to be tumor free by frozen section during the operation. Preoperative laser treatment for polypoid bronchial neoplasms may be useful in preserving pulmonary functions by effective bronchoplasty

We evaluated the results of right upper lobectomy with a sleeve resection of the right main bronchus in 50 patients with a bronchial neoplasm. Four patients (8 percent) died during surgery or postoperatively. Eight of the 22 patients who underwent surgery for carcinoma between the years 1960 and 1974 had tumor-positive hilar lymph nodes. They died as a result of subsequent extension of the resected carcinoma. Fourteen of the 22 patients had no lymph node metastasis and nine of them (64 percent) were alive after five years without detectable recurrence. The finding of positive hilar lymph nodes contraindicates sleeve resection. In these cases, when pneumonectomy is impossible from a functional point of view, sleeve resection is to be regarded as a palliative procedure.

Clinical experience during one-lung anesthesia using a new right-sided endobronchial tube (Portex Ltd, Hythe, Kent, UK) is reported in 148 patients with cancer of the left lung. The method allowed a reliable airtight separation of the lungs as well as right upper lobe ventilation in all cases. The new tube also allowed proper upper lobe ventilation in cases with anatomical variations of the length of the right main bronchus. The intubation technique was greatly simplified when compared with commercially available double-lumen tubes. Airway pressures and arterial blood gases were similar to those obtained with standard double-lumen tubes during one-lung ventilation. There were no complications due to the new tube system.

Although protruding type into the bronchial lumen with wide basis is by far the most common in adenoid cystic carcinoma, this report presented a case of extensive infiltration along the bronchial wall.A 39-year-old man was admitted with cough, hemosputum and swelling of the left hilum on the chest X-ray film. Bronchofiberscopic examination revealed marked stenosis on the left main bronchus, and extensive and long infiltration along the bronchial wall toward the left superior bronchus and the right main bronchus. The patient was treated with 60Co 4920 rads irradiation combined with chemotherapy using FMC (5-Fu, Mitomycin C and Cytosin arabinoside) and immunotherapy using Picibanil and BCG-CWS, and the tumor shadow was reduced and bronchofiberscopy revealed stenosis disappeared. This patient is well without any signs of recurrence one year after therapy

Selective bronchial intubation can be useful in the management of severe localized pulmonary interstitial emphysema (PIE). Five infants between 9 and 20 days old with severe left sided PIE had the right main bronchus intubated for between 4 to 30 h. Four patients showed permanent and one patient temporary improvement and the experience from these cases suggests that prolonging the procedure after obtaining radiological evidence of improvement may not be necessary. There were no serious complications although right upper lobe atelectasis occurred in three cases and could not be prevented by using an endotracheal tube with a side hole. Nevertheless, active management should only be considered in PIE causing respiratory failure or pressure effects on surrounding structures.

From 1970 to 1988, 9 patients were treated for tracheobronchial rupture arising from nonpenetrating thoracic trauma. All patients the dyspnea and pneumothorax. Four patients had rupture of inc right main bronchus, 3 had rupture of the left main bronchus, 1 had rupture of the right intermediate bronchus, and 1 had rupture of the trachea. Four patients were operated on within 24 hours. Three of them had a massive air leak into the suction drainage and underwent thoracotomy. The fourth patient presented difficulties with endotracheal intubation and required a collar incision. Primary reconstruction was performed in all 4 patients. Five patients had a delay of nine to 89 days before operation. All of them had good primary healing but later developed dyspnea. Bronchoscopy revealed scar obstruction in all S. The stenosed segment was resected in 4 patients at thoracotomy. The fifth patient, who had an intermediate bronchus rupture, underwent lobectomy. Seven patients were followed from 6 months to 18 years. One of them, who had a nine-day delay in treatment, needed further operation 6 months after the accident because of scar obstruction. The other 6 patient were interviewed, examined, and studied with spirometry, body pelythysmography, bronchoscopy, and bronchography. In these 6 patients no stricture was seen, and there was no reduced pulmonary function due to the rupture even when operation was delayed.

Between 1977 and 1986, 15 cases of tracheobronchial foreign bodies in infants and children were treated. The ages ranged from 6 months to 2 years and 5 months. The most frequent foreign body was peanuts (8 cases). The location of foreign bodies was mostly in the right main bronchus (8 cases). The most common chief complaints were stridor and cough.For the management of respiration, ventilating bronchoscopy was used in 6 cases, tracheotomy in 3, high-frequency positive pressure breathing in 2 and spontaneous respiration in 9. Some of the methods overlapped. We recommend combined use of modified-neuroleptanesthesia and topical anesthesia under spontaneous respiration for removal of the tracheobronchial foreign body in infants and children.

A 31-year-old man sustained a closed thoracic injury when he was thrown from his motor bike. Rupture of the tracheobronchial tree was suspected because of the presence of bilateral pneumothorax, deep cervical emphysema, mediastinal emphysema and hypoxia. Bronchoscopy in the emergency room revealed a linear tear of the membranous portion from the lower trachea to the right bronchus. There were also fractures of the right fifth rib and left carpal and metacarpal bones. A right standard thoracotomy performed five hours after the accident revealed an extensive linear laceration of the membraneous portion of the lower trachea, right main bronchus and the right upper lobe bronchus. The laceration was repaired with 14 interrupted sutures. No other injuries were found in the thorax. Postoperative bronchoscopy demonstrated neither stenosis nor granulation in the tracheobronchial tree. He was discharged one month after the operation. This patient's history emphasized the importance of bronchoscopy in the early diagnosis of tracheobronchial injury and in the decision for surgical intervention.

Anteroposterior, linear tomograms of 78 adult subjects in the supine position revealed visualization of pleural reflections off the retrotracheal part of the normal azygos arch in 38 (49%). The course of the arch varied by about 3 cm. Five distinct patterns were found, mainly depending on the course of the inferior margin of the arch. The inferior margin varied from relatively superior retrotracheal positions to intermediate positions appearing to intersect the carina, to relatively inferior and right-sided positions posterior to the proximal right main bronchus. Recognition of these normal variations of the azygos arch should serve to differentiate them from abnormalities in this region.

A case of bronchial plasmacytoma occurring in a 57-year-old housewife is reported. She had had the productive cough and the "abnormal shadow" in the right lower lobe for three years before admission. On bronchoscopy, a tumor was found in the right main bronchus, large enough to obstruct the air way. The tumor was resected through rigid bronchoscope. Histological impression was "plasmacytoma with local amyloid deposit." M-protein was never detected in the serum or urine. Applying the immunoperoxidase technique for the paraffin section, the plasma cells were found to contain only a single type of immunoglobulin, Ig G-L. The differential diagnosis between plasmacytoma and plasma cell granuloma was made, and plasmacytoma was considered to be one type of extranodal malignant lymphoma.

Between 1975 and 1981 five children (three girls and two boys) from 3 to 11 years were treated for blunt chest trauma with major tears in two areas of the right main bronchus. All were hit or run over by motor vehicles and were in acute respiratory distress. All suffered right pneumothoraces; three did not respond to a chest tube with suction. Four of five children had subcutaneous emphysema, and two had fractured ribs on the ipsilateral side; three children also had contralateral chest injuries. Four had major extrathoracic injuries. Three children required early repair, while two needed late treatment. All five patients recovered well and have remained healthy from 5 to 10 years after injury. These cases serve as illustrations for a review of a survey of the literature.

Important features of diagnostic and operative management and the postoperative course of tracheobronchial injuries as well as pathological findings at the anastomosis are discussed in a review of our 11 cases from the last 12 years. Diagnosis was established clinically, localization of the rupture was carried out by rigid or fiberoptic bronchoscopy. Tracheobronchial continuity was reestablished by end-to-end anastomosis of the ruptured bronchi, by direct suture of any tracheobronchial tears, or by patching inveterated lesions. Two cases of rupture of the right main bronchus are presented separately, considering clinical, diagnostic, operative and histopathologic criteria.

A 1 year and 7 month old boy was referred from a pediatrician with cough and fever for one week. Although chest X-ray indicated no significant findings, feeble breath sounds were noted over the right chest on auscultation. A close fluoroscopic observation revealed an abnormal movement of the mediastinal shadow concomitantly with respiratory movements, which seemed indicative of the presence of a foreign body in the airway. Subsequent ventilation bronchoscopy disclosed a piece of peanut in the right main bronchus and a successful removal was performed.A 16mm film made from a fluoroscopic videotape of the present case was analyzed and the abnormal movement of the mediastinal shadow was investigated as an evidence of the check valve action of the foreign body in the airway.

This study has demonstrated that a reliable guide in the gross roentgenographic assessment of the pulmonary blood flow in infants with congenital heart disease is provided by comparing the width of the descending branch of the right pulmonary artery with that of the lower part of the right main bronchus. This ratio was significantly higher in those infants with an increased flow than in those with oligemic lungs. The radiographic criteria on which a diagnosis of pulmonary hypertension is made in adults did not apply in infants. Indeed, no reliable evidence of pulmonary hypertension could be obtained in this age group on radiographic grounds. No suitable assessment of the pulmonary venous system could be made in these cases with the radiographic technique that was used.

During past ten years, bronchoscopic examinations revealed tracheobronchial invasions caused by hilar lymph node tuberculosis in 8 cases: Perforation of floride stadium with expectration of a lot of tubercle bacilli was found in 1 young man and 2 young women with more or less abnormal hilar shadow on their chest x-ray films, intensive extrinsic stenosis of trachea in a 3-year-old girl suffering from primary infection of tuberculosis, residual scar in 3 male abults and pinhole-sized cicatricial stenosis of the right main bronchus in a young woman. From these observations, it could be stressed that even nowadays, tracheobronchial perforation caused by hilar lymph node tuberculosis should be carefully noticed under bronchoscopic examinations for the chest diseases suspected of tuberculosis.

The surgical approach to, and resection of, a cylindroma of the left main bronchus involving the trachea and right main bronchus is described. The literature on bronchial adenoma and cylindroma is reviewed, both the pathogenesis and surgery being discussed. A plea for a more aggressive approach is made.

A case of 34-year-old male with chief complaints of cough and hemoptysis was reported. Infiltrative lesions appeared temporarily at the left middle lobe on the chest rentogenogram. Bronchography and bronchoscopy revealed a smooth-surfaced-diverticula of the right main bronchus, 5 cm from the carina, which was considered to be congenital.

A 2 1/2-year-old child was seen six days after she sustained a rupture of her right main bronchus. Because the diagnosis was not established until the sixth day after injury, repair was deferred for three weeks until the edema and acute inflammation had subsided. By repeated bronchoscopic and endotracheal suction, it was possible to maintain ventilation of the affected lung. Segmental bronchial resection was followed by uneventful recovery. In selected patients, deliberate delay in repairing bronchial rupture appears desirable.

Aiming at prevention of lowering of pulmonary function, we performed bronchoplasty instead of right pneumonectomy usually indicated on 2 cases of primary lung cancer. In the surgical procedure sleeve resection and anastomosis are performed at the part of the broncus between the right main bronchus and the intermediatetrunk so that the right middle and lower lobes are preserved. Case 1, 1 year and 5 months after surgery and Case 2, 1 year after surgery both have been rehabilitated already. The part of anastomosis on the both cases reveals no sign of stenosis and keeps sufficient lumen. Neither recurrence nor metastasis is present, and bronchospirometry revesls satisfactory function of the remaining lobes. Tumor was epitheloid cancer on the both cases.

Although the usual appearances of the azygos arch on plain chest radiographs are well known, there are less common radiographic presentations which may be misconstrued as mediastinal nodes or masses. The size of the anterior azygos arch measured perpendicular to the right main bronchus should not exceed 7 mm. In the rare case of congenital aneurysmal dilatation of the azygos arch, its size may be much greater and can be confused with a mediastinal mass. Enlargement of the azygos vein can also result from increased pressure in the right ventricle or as the result of increased flow through the azygos system. Increased flow can result from congenital abnormalities or from caval obstruction.

Summary Chronic obstructive emphysema due to foreign body in the bronchus is extremely rare. A case is described of a vegetable foreign body in the right main bronchus of an infant of 13 months who had obstructive emphysema that was demonstrable on X-ray for three months. A ball-valve mechanism was found at bronchoscopy and the foreign body was removed by bronchotomy. Granulation tissue was absent. Interesting features are discussed and the causes of obstructive emphysema and transradiancy of part or the whole of the lung are briefly mentioned.

During 16 years (1951-1966), bronchoscopy was performed on 280 cases with malignant bronchopulumonary growths, which were diagnosed clinically by cytologic and bioptic findings or confirmed pathologically on resected or necropsied bronchopulmonary specimens.In 101 out of these 280 cases examined, the malignant growths were found bronchoscopically and these visible tumors were classifted in following four types from the bronchologic, roentgenologic and pathologic point of view:I) Localized primary bronchogenic cancer and sarcoma (Localized Type) .. 20 casesII) Invasive primary bronchogenic cancer (Invasive Type) … 58 casesIII) Bronchial tumorous invasion caused by parabronchial lymphnode metastasis of the primary bronchogenic cancer (Lymphnode Metastatic Type) … 21 casesIV) Bronchial tumorous invasion caused by pulmonary or parabronchial lymphnode metastasis of the primary extrathoracic malignant growths (Extrathoracic Type) … 2 casesIn the majority of the cases with the bronchial tumors of each type, their roentgenologic findings of the chest were characterized by the unilateral, lobar or segmental opacity. However, in some cases, bipolar or cavitary shadow was found, and three cases showed apparently normal x-ray finding of the chest.The bronchial tumors of each type showed no characteristic appearances. However, as to the localization, the tumors of the third type were most frequently located at the carina, the orifice of the right upper lobe bronchus and the median wall of the right main bronchus and the intermedial bronchus.Therapeutecally, it should be most significant to distinguish each type of the bronchial tumors. In the early stage, the bronchial tumors of the first type not only were resectable, but also mostly diappeared or could be replaced with cicatricial tissue by the suitable irradiation therapy, while in the majority of the cases with the tumors of the othere types, their prognoses were less good than those in the former.In our series, 11 cases (52%) of the first type, 3 cases (5.1%) of the second and 4 cases (20%) of the third were treated by lung resection, but only one case of the first type survived for more than five years.

Right aortic arch has long been known in the anatomical literature as a rare congenital defect of the aorta. Maude Abbott (1) lists 13 instances of this abnormality in her collection of 1,000 cases of congenital heart disease. Garland (2), in 1938, was able to collect from the literature the records of 113 cases. It is only Since 1926, however, when the criteria for the roentgen diagnosis of this condition were laid down by Arkin (3) and by Renander (4), that it has become possible to diagnose this congenital defect during life. In 1939 Metzger and Ostrum (5) reported its recognition roentgenologically in 18 patients, to which series they added 2 cases of their own. Anatomy There are two varieties of right aortic arch. In the simple or anterior type, the aortic arch loops over the right main bronchus and then passes straight downward, the transverse arch being anterior to the trachea and esophagus as in the normal subject. This type is uncommon; it is rarely encountered in the roentgen literature and will...

In a patient with a large defect of the anterior tracheal wall, a technique of a bilateral endobronchial intubation was used. With a Gordon Greene tube in the right main bronchus and a Magill tube in the left main bronchus, maintenance of an airway and ventilation of both lungs was possible for five days.

Summary The case history of a 7-week-old boy. From birth the child had repeated attacks of cyanosis and dyspnea, without stridor. Lung examination two days after birth disclosed atelectasis of the upper and middle lobe of the right lung, and later emphysema of the entire right lung was found. At the age of 7 weeks a cold aggravated the infant's condition, and death followed repeated attacks over a three-day period. Autopsy revealed an abnormal left pulmonary artery to be the cause of the symptoms. Branching from the right pulmonary artery the anomalous left pulmonary artery entangled the right main bronchus and compressed it. The mechanism of the intermittent mutual compression of the anomalous artery and the right main bronchus is discussed. The author discusses the nature, of the anomalous left pulmonary artery and believes it to have been similar to that of the anomalous arteries supplying the lungs in caws of congenital pnlmonic stenosis and pulmonic atresia. Resume L'histoire morbide d'un enfant age de 7 semaines est donnee. Des la naissance l'enfant a eu des attaques de cyanose et de dyspnee, sang aueun stridor. L'examen des poumons a l'âge de deux jours, a decouvert atelectatique le lobe superieur et le lobe moyen du poumon droit, et plus tard le poumon droit est trouve entierement emphysemateux, a l'age de sept semaines un rhume a aggrave son etat, et l'enfant est mort en suite des attawaues pulmonaire gauche abnorme, qui, partissant de l'artere pulmonaire droite, fait le tour du bronche principal droit et le comprime. La meeachanisme de la compression, et le bronche principal droit et le comprime. La meachanisme de la compression reciproque intermittente de l'artere pulmonaire gauehe abnorme, et le bronche principal droit, est discutee. L'auteur eu suite discute la nature de cette artere abnorme, et arrive a l'avis qu'elle soit la meme que celle des arteres abnormes fournissant les poumons en cas de stenose et d'atresie pulmonaire congenitale. Zusammenfassung Krankengeschichte eines sieben Wochen alten Kindes. Von der Geburt hatte das Kind wiederholt Anfalle von Cyanose und Dyspnoe, ohne Rtridor. Bei der Lungenuntersuchnng wurde zwei Tage nach der Geburt Ate lektase des oberen und mittleren rechten Lungenlappens nach- gewiesen, und spater ein Emphysem der ganzen rediten Lungen. Eine Erkaltung verschlimmerte die Zustand des Kindes, dass, im Alter von sieben Wochen, nach wiederholten Aufbllen im Lanfe von drei Tagen. starb. Die Obduktion ergab eine abnorme linke Lungenarterie als Ursachc der Symptonie. Yon der rechten Lungenarterien abzweigend umschlingt die, abnorme linlre Lungenarterie den rechten Hauptbronehus und driickt ihn zusammen. Die Mechanismus der gegenseitigen Compression der abnormen linken Luiigenarte, rien und des rechten Hanptbronchus wird anseinandergesetzt. Verfasser diskutiert die Natnr der abnormen Lun-genarterien, und nimmt an dass sie disselbe sei als die der abnormen Arterien die bei angeborenen Pulmonalsteiiose und Yulmonalatresie die Lungen Blut zufuhren. Resumen Se relata la hisotoria morbida de un nino de 7 semanas de edad. Desde el nacimiento tuvo afaques de cianosis y de dispnea, sin estridor. EL examen de los pulmones, a los 2 dias de edad, descubrio atelectasia del lobulo superior y del lobulo intermedio del pulmon derecho, encontranadose mas trade que este ultimo estaba enteramente enfisetamoso. A la edad de 7 semanas un catarro agravo su estado y el nino fallecio a causa de ataques repetidos durante 3 dias. La autopsia demostro una arteria pulmonar a la izquierda, la cual era anormal. Esta arteria, que salia de la arteria pulmonar derecha, daba la vuelta alrededor del bronquio principal derecho y lo comprimia. El mecanismo de compresion reciproca e intermitente de la arteria pulmonar izquierda anormal, y el bronquio principal derecho, se discute. El autor discute la naturaleza de esta arteria anormal y llega a la conclusion de que es la misma que la de las arterias anormales que abastecen los pulmones en case de estenosis y de atresia pulmonar congenita.

To know the efficacy of different instruments in retrieval of bead from tracheobronchial tree.BACKGROUND: Bead is uncommon object in western world and therefore rarely recorded as aforeign body in tracheobronchial tree. No specific instrument being named for its retrieval. Our studyfocuses on different instruments we used and its outcome.MATERIAL AND METHODS: This was retrospective study of foreign body bead impaction intracheobronchial tree. All patients subjected to bronchoscopy with definite clinical findings of beadimpaction on radiology or bronchoscopic examination were recorded, with different instruments used. Inall cases Karlstorz rigid bronchoscopes of size 3.0 to 5.0 with fiber optic light used. Long bronchoscopicscrew forceps, malleable forceps. Large nasal killian forceps was used after tracheostomy in some cases.Study period: 1st January 2008 to December 2012.Site: ENT A unit Hayatabad Medical Complex Peshawar.RESULTS: In our study of 3 years 32 cases were recorded with bead impaction in tracheobronchealtree. 21(65.62%) were male and 11 (34.37%) female. Age ranges below 1 year was 1 (3%) case,between lyear and 2 years 6 (18.75%) cases, 2 years to 3 years 21(65.62%) and 3 years and above 4(12.5%) cases recorded. 21(65.62%) beads were retrieved with malleable forceps, 8 (25%) with longscrew forceps, 1 (3%) after tracheostomy with long killan nasal forceps and 2 (6.25%) impacted beadswere referred to cardiothoracic department for thoracotomy. 3 (9.37%) beads were impacted in maintrachea, 19 (59.53%) in right main bronchus and 10 (31.25%) in left main bronchus.CONCLUSION: Bead is one of the difficult foreign body tracheobroncheal tree and needs specialinstruments for its removal.KEY WORDS: Beeds, Boronchoscopy

Summary A case of an adenomatous polyp of the right main bronchus in a boy eleven years old is described. The clinical picture was that of atelectasis and bronchiectasis of the right lower lobe with a triangular basal shadow on the roentgenogram. After bronchoscopic removal of the neoplasm, the clinical state was considerably improved, and two months later the triangular basal shadow had almost disappeared.

p c t b p p m t v a v s t w o Rigid bronchoscopy is an important procedure for the thoracic surgeon to master. Its utility has been evident since the 1890s when Gustav Killian removed a foreign body from a patient’s right main bronchus and Chevalier Jackson developed his own endoscopes with distal illumination.1,2 Today’s rod-lens telescope was developed by Harold Hopkins in England and is the basic telescope inserted through the rigid bronchoscope. Karl Storz modified this technology with a cold illumination source for his rigid bronchoscope in the 1950s.3 The modern rigid bronchoscope is used for the diagnosis and treatment of benign and malignant pathology of the central airways. Indications for use include, but are not limited to, foreign body retrieval, obtaining hemostasis and removing blood clots in patients with hemoptysis, and relieving airway obstruction from tumors or intubationrelated stenoses. When necessary, rigid bronchoscopy can facilitate the placement of tracheal or bronchial stents. Endoluminal therapies, such as laser treatment, argon plasma coagulation, and debriding instruments, are best used under the protection of a rigid bronchoscope. Rigid bronchoscopy is best used in combination with other modalities, including radiologic studies, such as thin-slice computed tomography scans, flexible bronchoscopy, esophagoscopy, and laryngoscopy. Although they come in various types and sizes, the overall construction of the rigid bronchoscope is typically uniform: a

Purpose Intensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bronchi at varying gestational ages, including their relative growth in length and projection surface area. Materials and methods Using anatomical dissection, digital image analysis and statistics, length, proximal and distal external transverse diameters, and projection surface areas of the right and left main bronchi were examined in 73 human fetuses (39 males, 34 females) aged 14–25 weeks, derived from spontaneous abortions and stillbirths. Results Statistical analysis showed no sex differences. Between the 14 and 25th week of gestation, the lengths of the right and left main bronchi increased from 1.43 ± 0.18 to 3.18 ± 0.39 mm, and from 2.97 ± 0.16 to 7.58 ± 1.95 mm, in accordance with the functions: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 4.850 + 2.452 x \; \text{ln}\left( {\text{Age}} \right) \pm 0.400\;{\text{and}}\;y = - 15.005 + 7.093x \; \text{ln} \left( {\text{Age}} \right) \pm 0.579 $$\end{document}, respectively. The proximal external transverse diameters of the right and left main bronchi varied from 2.13 ± 0.41 to 4.24 ± 0.20 mm, and from 1.84 ± 0.06 to 3.67 ± 0.66 mm, following the logarithmic models: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 8.666 + 4.018x \; \text{ln}{\rm (Age)} \pm 0.367\;{\text{and}}\;y = - 6.938 + 3.305x{\text{ ln(Age) }} \pm 0.323 $$\end{document}, respectively. The distal external transverse diameter rose from 2.09 ± 0.47 to 4.24 ± 0.20 mm, as \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 8.723 + 4.021x{\text{ ln(Age)}} \pm 0.392 $$\end{document} for the right main bronchus, and from 1.85 ± 0.04 to 3.67 ± 0.66 mm, like \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 6.924 + 3.280x{\text{ ln(Age)}} \pm 0.348 $$\end{document} for the left one. On either side, there were no statistically significant differences between values of the proximal and distal transverse diameters of the main bronchus. The projection surface areas of the right and left main bronchi ranged from 2.95 ± 0.19 to 13.34 ± 2.12 mm2, and from 5.57 ± 0.21 to 28.52 ± 5.24 mm2, as \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 10.212 + 0.943x{\text{ Age}} \pm 1.739 $$\end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ y = - 19.119 + 1.875x{\text{ Age}} \pm 3.054 $$\end{document}. The two main bronchi revealed a proportionate increase in both length and projection surface area, since the right-to-left bronchial length ratio and the right-to-left bronchial projection surface area ratio were stable, 0.41 ± 0.07 and 0.47 ± 0.08, respectively, throughout the analyzed period. Conclusions The main bronchi show no sex differences. The right and left main bronchi grow logarithmically in length and external transverse diameter, and linearly in projection surface area. The right and left main bronchi evolve proportionately, with the right-to-left bronchial ratios of 0.41 ± 0.07 for length, and 0.47 ± 0.08 for projection surface area.

The effect of instrumentation with a telescope during bronchoscopy on the arterial oxygen tension and acid-base status was studied in 17 unselected, anaesthetized patients using a ventilating technique based on Sanders' method (1). After ventilating the patients with a bronchoscope and a telescope in the trachea, in the left main bronchus or in the right main bronchus, the PaO2 value was always statistically significantly higher than after ventilating only with a bronchoscope. During the course of the bronchoscopy as well as after 1 h in the recovery room, the arterial acid-base status was within normal limits and the mean PaO2 value during bronchoscopy ranged from 175 to 240 mmHg (23.3-31.9 kPa) and was 138 mmHg (18.4 kPa) in the recovery room when the patients breathed about 35% oxygen in air. The present results suggest that instrumentation with a telescope during bronchoscopy ameliorates rather than impairs the ventilation and oxygenation of the patients.

The case reported here is one in which a foreign body in the esophagus resulted in a right lung abscess. Interest here centers on the unusual nature of the foreign body and the extraordinarily long period it was allowed to remain in the esophageal lumen even though it was producing symptoms throughout this period. The various factors involved are discussed, also the somewhat peculiar fact that the lung abscess was on the right, resulting from external pressure on the right main bronchus.

We have presented a case of unilateral pulmonary oedema which we feel is secondary to obstruction of the right main bronchus during spontaneous respiration. An anode tracheal tube was introduced through a tracheostomy during operation in a man with pre-existing pulmonary and cardiac disease. At the end of the anaesthetic, acute obstruction to ventilation of the right main bronchus developed with the tube still in place and the patient breathing spontaneously. The obstruction was relieved, by repositioning of the tracheal tube, but not before the patient developed right unilateral pulmonary oedema.

An anomalous left pulmonary artery obstructs the right main bronchus and/or the trachea. Depending on the severity of the obstruction, symptoms range from a more or less disturbing stridor over attacks of shortness of breath to a life-threatening or even lethal apnoea. An 18-month-old girl suffering from a mild form of this anomaly is presented. The diagnostic and therapeutic possibilities are discussed. After exact clarification of the characteristics of the pulmonary sling, exclusion of associated aberrations, and considering good experience with a former case a conservative approach is recommended if the patient is not substantially impaired.

A mediastinal tumour was simulated by gross dilatation of the azygos vein resulting from compression by enlarged hilar lymph nodes at the point where it crossed the right main bronchus to enter the superior vena cava. This cause of dilatation of the azygos vein has not previously been reported. Published reports are reviewed and attention drawn to the large proportion of patients (11/19) with this condition who had needless thoracotomies. The possibility of making a diagnosis by means of clinical observation and simple radiological techniques and thus avoiding surgical intervention is discussed.

Exogenous foreign bodies in tracheo bronchial tree are not uncommon, particularly in children. The gold standard principal of foreign body management is bronchoscopic removal and this procedure becomes difficult and challenging in cases of large and smooth foreign body as occur in our case. The present article reports a case of unique and large foreign body i.e. intact glass bulb in right main bronchus. Key words: Foreign body; Bronchus.DOI: http://dx.doi.org/10.3329/bjo.v17i2.8854 BJO 2011; 17(2): 132-134

SUMMARY Selective intubation of a main bronchus during thoracotomy in three young children is described. Modified endotracheal tubes were used to intubate the left main bronchus in an infant with a right bronchopleural fistula and the right main bronchus in two children aged 3 years, one of whom had a foreign body in the left main bronchus, and the other a left empyema thoracis. In these cases the technique was simple and satisfactory.

SUMMARY The case is described of a male who sustained rupture of the right main bronchus in a road traffic accident. There was no apparent skeletal injury. A successful outcome followed operative repair under one-lung anaesthesia. The diagnosis of bronchial rupture must be suspected when tension pneumothorax or large air leak is associated with mediastinal and deep cervical emphysema.

The purpose of this paper is a description of a twin spirometer which I have designed for clinical bronchospirometry. This instrument is used with a special rubber catheter, but could be used with any similar device such as the double bronchoscope described by Jacobaeus and Frenckner. A description of my catheter and the technique of its use in bronchospirometry have been published. Figure 1A is a diagram illustrating how the catheter separates the air channels to the lungs and permits the study of each side separately and simultaneously. These catheters are sold by American Cystoscope Makers Inc. They are made of latex and contain enough barium to make them easily visible under the fluoroscopic screen. A steel coil spring is incorporated in the catheter wall which produces a desirable semi-rigidity. The catheter is supplied in three sizes so that it is adapted to the wide range of bronchial dimensions produced by collapse as well as by the variation in the size of patients. It is* advisable to use as large a size as possible. The largest can be used only in large males. The smallest size is used in small females, or in those patients in whom pulmonary collapse has caused a contraction of the left bronchus. The right main bronchus has been found unsatisfactory for bronchospirometry because of the short distance between the carina and the right upper lobe orifice; consequently, stenosis of the left main bronchus may make the procedure impossible. The catheter is inserted through the glottis by means of a direct laryngoscope, and then guided into the left bronchus with the aid of the fluoroscope. Its natural curvature to the left facilitates this passage. It is usually passed down until the tip is visible just lateral to the left cardiac border. Good anesthesia is essential and is accomplished by spray and intratracheal injection. Relative dryness of the tracheobronchial tree is desirable so that postural drainage or cough and expectoration are carried out be

A 16-year-oJ[d boy was transferred from another hospital to our department because of clinical suspicion of a bronchial rupture after blunt chest trauma. He had been in a traffic accident as the driver of a small motorcycle. On admission he was intubated, nonsedated, and anxious. He had hypotension, tachycardia, and massive subcutaneous emphysema over the chest, the Upper part of the abdomen, and in the neck. A small thoracic catheter was in place. A roentgenogram of the chest made in the referring hospital showed a complete pneumothorax on the right side with extensive subcutaneous and mediastinal emphysema. He had a stable pelvic fracture, confirmed by radiography. The patient was sedated. An arterial pressure line, a jugular catheter, and a larger thoracic drain were placed. A major air leak was detected. A flexible bronchoscope, inserted in the emergency department, revealed a large defect of the right main bronchus just distal to the carina. The patient was then taken to the operating room for urgent thoracotomy. After placement of a single-lumen endotracheal tube into the left main bronchus, the patient was positioned on his left side and a right posterolateral thoracotomy above the fifth rib was performed. The right lung had collapsed and the right upper lobe contained a large intrapulmonary hematoma. A complex, double bronchial rupture was present--a complete transection of the right main bronchus and an incomplete rupture of the right lower lobe bronchus. The cartilaginous portion of the main bronchus was transected transversely about i cm distal to the carina. The membranous portion had ruptured transversely more proximally at the level of the carina. The two transection planes were connected by a double longitudinal tear at the junction between the cartilaginous and membranous parts of the right main bronchus (Fig. 1). The right lower lobar bronchus had an incomplete transverse rupture about half the circumference of the bronchus and 0.5 cm distal to the ostium of the bronchus for the right middle lobe. Both ruptures were

SummaryBronchopulmonary foregut malformations are a group of rare congenital anomalies affecting the respiratory and upper gastrointestinal tract. The rarity of these cases means their embryological origin continues to be a source of controversy.We present the case of a female infant, born at term with a malformed right arm, an absent right kidney and aplasia of the right lung. Although initially asymptomatic she presented at 5 months of age in severe respiratory distress. An upper gastro-intestinal contrast study demonstrated a right broncho-esophageal fistula. At surgical resection it was discovered that the right main bronchus ended abruptly just beyond the carina, with total aplasia of the right lung. A bronchoesophageal fistula originating from the lower third of the esophagus communicated with a sequestered right lobe. The lobe was removed and the fistula ligated. The infant remains well 13 months post surgery.This represents only the twelfth case of this rare form of bronchopulmonary foregut malformation. The associated renal and limb malformations make this case unique and may add weight to the theory that the underlying insult to the developing lung is vascular in origin.

Conventional chest roentgenography, angiocardiography, and cast corrosion preparation studies of the heart have been supplemented by anatomical sections of cadavers in the horizontal, sagittal, and coronal planes. The heart is the most important anatomical structure of the middle mediastinum. The ventral coronal section of the heart (Figure 1) exhibits, from left to right, the superior vena cava (above), the right atrium (below) the ascending aorta (in the middle), the pulmonary trunk (to the right), and the right ventricle (below the aorta and pulmonary trunk). The dorsal coronal section of the heart (Figure 2) shows the bifurcation of the trachea (above) with the right and left primary divisions of the pulmonary trunk (in front of the main bronchi) and the pulmonary veins and left atrium (below). Above the right main bronchus one sees the arch of the azygos vein and above the left main bronchus, the arch of the aorta.

Two patients with an intraluminal carcinoid tumour obstructing the right main bronchus in one, and the left main bronchus in the other, resulting in unilateral increased transradiancy from hypoperfusion of the lung, are described. Resection of the tumours and reconstruction of bronchial continuity was followed by return of perfusion to normal between three and 18 months after the operation. The patient in whom the diagnosis was delayed showed a much slower rate of return of perfusion and a small lung resulted. The finding of increased transradiancy of lung even in an asymptomatic patient should be an indication for bronchoscopy.

An attempt has been made to evaluate the magnitude of and changes in the right-left shunt following 40 minutes' blockade of one of the main bronchi in 6 anaesthetized patients, of whom 3 had the right and 3 the left bronchus blocked. Xenon133 was used together with a simple transportable apparatus employing four collimators on the anterior of the thorax. Despite verified blockade (bronchoscopy and stethoscopy), the study showed an activity corresponding to a ventilation of approximately one-third of the initial values. It was not possible to demonstrate any fall in the perfusion on the blocked side following blockade of the left main bronchus, whereas blockade of the right main bronchus produced a calculated fall to two-thirds of the initial perfusion. The blockade caused a fall in PaO2 in all the patients, which was inpendent upon the side blocked and of a magnitude that corresponded to the perfusion measured after blockade of the right main bronchus.

A case of leiomyoma of the lung was described by our department 17 years ago. We now report three new cases of smooth muscle tumours of the lower respiratory tract: a leiomyoma of the lung, a leiomyosarcoma of the right main bronchus, and a leiomyoma of the trachea. Whereas in the previous case the tumour was bronchoscopically removed, all the recent tumours were surgically resected. All the patients have done well, including the one with the leiomyosarcoma who underwent surgery 7.5 years ago. One hundred and eighty cases of leiomyoma and leiomyosarcoma of the lung and trachea have been reported to date. Pulmonary leiomyoma most commonly presents as an asymptomatic solitary lung nodule. The endobronchial variety may cause cough, haemoptysis, or shortness of breath. Most of these tumours were dealt with by major pulmonary resection, although a lesser resection would have sufficed in many cases if a histological diagnosis had been established prior to surgery. Pulmonary leiomyosarcoma may occur at any age, and is much more common in females. The majority of the patients have thoracic symptoms. These neoplasms seem resistant to chemotherapy or radiotherapy and should be treated by radical resection whenever possible, which results in a 45% 5-year survival rate. Only seven cases of leiomyosarcoma and 12 cases of leiomyoma of the trachea have been reported. These usually cause respiratory obstruction and/or haemoptysis. The malignant as well as the benign tumour is probably best treated by complete surgical resection.

In a patient with metachronous multiple primary lung cancer, bilateral lobectomy was performed, using bronchoplastic procedures. This case may be one of very few such cases reported in the literature. A 56-year-old man with squamous cell carcinoma was surgically treated for lung cancer. At the first operation, right upper lobectomy with wedge resection of the right main bronchus was performed, as the tumor occupied the orifice of the right main bronchus. Six months later, re-operation for stricture at the anastomotic line was done because of granulation. By means of sleeve resection of the strictured right main bronchus, the airway was reconstructed. The patient remained well for five years, then a similar cancer at the orifice of the left lower lobe and bulging into the left main bronchus became evident. Left lower sleeve lobectomy was done for the second primary cancer. The postoperative course was uneventful and he is well with no signs of recurrence 6 years and 10 months after the first operation and 19 months after the second sleeve lobectomy.

A case in which passage of a narrow bore naso-gastric tube into and through the right main bronchus and accidental soiling of the lung parenchyma with Clinifeed is reported. The presence of a healing tracheostomy stoma was considered a contributory factor. Suggested means of avoiding such an accident are, air insufflation while auscultating over the epigastrium, chest X-ray before commencing feeding and proper liaison between medical and nursing staff.