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Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16 year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1–5 year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic insertion and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.

Background Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications. Case presentation A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet. Conclusions There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.

The article presents a case of successful surgical treatment of a 3-month-old child with a rare pathology – tuberculosis lesion of the intrathoracic lymph nodes causing compression of the left main bronchus. The child was admitted with signs of respiratory failure. An X-ray examination revealed signs of emphysema of the left lung. According to the data of contrast CT, a volumetric hypodensive formation was detected, which slightly accumulated contrast, with a capsule up to 0,3 cm thick, located in the area of the tracheal bifurcation, causing compression of the left main bronchus, esophagus, pulmonary bifurcation. During tracheobronchoscopy, a narrowing of the main bronchus to 1 mm was found immediately after bifurcation of the trachea. During the operation, a formation with a diameter of up to 2 cm was removed. According to the results of a morphological study, the formation is regarded as tuberculous granulomatous inflammation of the lymph node. The rarity of the pathology causes difficulties in diagnosis and treatment.

The knowledge of airway length is the theoretical basis in the diagnosis and management of airway disease. The objective of this study is to measure the length of trachea and left and right main bronchus in Chinese Shanghai population. A total of 153 consecutive adult patients with minor pulmonary disease in Xinhua hospital were enrolled for bronchoscopy examination. Measurements were conducted on head and neck neutral position and height, weight and age for each patient were recorded either. Student t test and multiple linear regression was used to compare means between males and females and to analyze correlation among height, weight, sexual dimorphism and the lengths of the trachea and bronchus. The lengths of the trachea and left main bronchus are significantly different between male and female patients (P

Background Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF.Case summary We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR.Discussion Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article.

Foreign body aspiration (FBA) is a serious problem especially in pediatric age group. Delay in diagnosis and intervention can lead to a life-threatening condition. Young children are more concerned with the environment and neuromuscular mechanisms do not develop sufficiently. Factors such as lack of molar teeth and failure to perform chewing are the main causes of high FBA in children under 3 years of age. It is of vital importance that the patient is referred to a hospital where a rigid bronchoscopy can be performed quickly after the diagnosis. We retrospectively evaluated 47 patients who were treated in our clinic such as clinical symptoms, age, gender, foreign body (FB), location, positive radiological findings, and duration of stay. 47 patients; 29 male (63%), 18 female (37%), age ranging from 3 months to 8 years. The age of the 37 patients (80%) was below the age of 3 years. The main complaint at the time of admission was cough (80%) in 37 patients, wheezing in 23 patients (50%), shortness of breath in 15 patients (32.6%), infection in 5 patients (10.8%), high in 2 patients. there was fever (4.3%). In 37 patients (78%), the foreign body was of organic origin (such as inside or outside the shell, peanuts, hazelnut pieces) while in 10 patients (22%), an inorganic foreign object was found (such as a pen tip, a toy part, plastic parts, etc.). FB was located in the right main bronchus in 18 patients (39%), in the left main bronchus in 25 patients (51%) and in the trachea in 4 patients (8.7). There were no radiological findings in 18 patients (39%). Although 11 patients (23.9%) were anamnesis, their findings were normal. Twenty-three patients applied to our clinic within the first 24 hours after the event, and 24 patients were admitted to our clinic 24 hours after the event. Although the results were generally consistent with the literature, the left main bronchus was 51% in terms of the localization of FB.

Yabancı cisim aspirasyonları küçük çocuklarda daha sık görülen, ani başlangıçlı solunum sıkıntısına yol açabilen ve çoğunlukla sağ hemitoraksın etkilendiği acil bir sağlık sorunudur. Bu çalışmada aspirasyon öyküsü olmayan, klinik bulguları ile radyolojik bulguları uyumsuz olan ve şüphe üzerine bronkoskopik işlem neticesinde sol ana bronştan yabancı cisim çıkarılan iki hasta konu hakkındaki farkındalığı arttırmak için tartışıldı.Foreign body aspirations is more common in young children, which can cause sudden onset of respiratory distress. It is an emergency health problem that mostly affects the right hemithorax. In this study, two patients who had no history of aspiration, whose clinical and radiological findings were inconsistent, and upon suspicion, foreign body was removed from the left main bronchus as a result of bronchoscopic procedure were discussed to raise awareness on the subject., Foreign body aspirations is more common in young children, which can cause sudden onset of respiratory distress. It is an emergency health problem that mostly affects the right hemithorax. In this study, two patients who had no history of aspiration, whose clinical and radiological findings were inconsistent, and upon suspicion, foreign body was removed from the left main bronchus as a result of bronchoscopic procedure were discussed to raise awareness on the subject.Yabancı cisim aspirasyonları küçük çocuklarda daha sık görülen, ani başlangıçlı solunum sıkıntısına yol açabilen ve çoğunlukla sağ hemitoraksın etkilendiği acil bir sağlık sorunudur. Bu çalışmada aspirasyon öyküsü olmayan, klinik bulguları ile radyolojik bulguları uyumsuz olan ve şüphe üzerine bronkoskopik işlem neticesinde sol ana bronştan yabancı cisim çıkarılan iki hasta konu hakkındaki farkındalığı arttırmak için tartışıldı.

Carcinoids of the left main bronchus are rare tumors of the bronchial system and patients often present with dyspnea, asthma-like symptoms, and pneumonia. Gold standard for therapy of carcinoids is surgical resection, but the surgical approach for segmental resection and anastomosis of the left main bronchus is a matter of discussion. With a left-sided approach the access to the bronchus is blocked by the aortic arch and the pulmonary vein. If a right-sided approach is performed, the problem of ventilation during resection and anastomosis of the bronchus occurs. We present a surgical approach from the right side using intraoperative extracorporeal membrane oxygenation to assure oxygen supply for resection of a typical carcinoid of the left main stem bronchus, and discuss the current literature.

Endotracheal tube stylets are still being used in many medical centres for difficult intubations. In rare cases, it may break inside the trachea during endotracheal intubation and may sometimes move unnoticed deep into the tracheobronchial tree. In this case report, the authors describe a rare complication after endotracheal tube (ETT) stylet intubation in a patient in whom a broken piece of metal guide remained in her tracheobronchial tree. A 69-year-old lady was admitted to our hospital for management of shortness of breath and cough with expectoration. The patient was a known case of chronic obstructive pulmonary disease, cor pulmonale and coronary artery disease. The authors report a case of an unrecognized broken piece of stylet in her tracheobronchial tree and left main bronchus, which was later detected by computed tomography scan and extracted. Despite precise evaluation before use, signs of breakage in the stylet may be missed, and, consequently, it may break inside the trachea and result in serious complications. It is strongly recommended that the intensivists pay attention to the sounds and movements of the instruments.

Foreign body aspiration (FBA) can be potentially fatal if the object is large enough to cause nearly complete obstruction of the upper airway. The object causing obstruction beyond the carina can result in less severe clinical presentation. FBA is rare in adults than in children. If the clinical history is not suggestive of FBA, then a high index of suspicion and flexible bronchoscopy can ensure proper diagnosis and prompt intervention. We present a case of an adult with aspirated betel nut in the left main bronchus, removed using flexible bronchoscopy with the aid of a Fogarty balloon catheter following the failure of rigid bronchoscopy.

Background Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. Methods The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. Results SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis (P Conclusions MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.

BACKGROUND Double-lumen endobronchial tubes (DLT) continue to be the most widely used method for obtaining lung isolation during anesthesia. We compared recommendations for DLT size selection with radiologically assessed lower airway dimensions gathered from a large patient population. METHODS For this retrospective comparative study, we assessed computed tomography (CT) scans of 150 adults with no known airway pathologies. Using these scans, we measured the diameter and length of the trachea and the diameter of the mainstem bronchi. These airway dimensions were then compared to the dimensions of left-sided DLTs of three different manufacturers. Size selection was based on one standard textbook's recommendations. RESULTS We found the recommended DLT sizes were occasionally too small but more often too large, particularly in the endobronchial airway. With the DLT Vivasight-DL®, mismatching occurred in 28.7% (43/150) of the patients at the distal mainstem bronchus and 8% (12/150) at the tracheal level. This mismatching happened most often in females (left distal mainstem bronchus 34/68, 50%; trachea 9/68, 13.2%). Conversely, the DLT was more often too small for male patients in both the left main bronchus (SHER-I-BRONCH®: 8/82, 9.8%) and the trachea (SHER-I-BRONCH®: 2/82, 2.4%). The endobronchial tube portion was more often too long in females (Vivasight® DLT: 11/68, 16%) than males (9/82, 11%). CONCLUSIONS A considerable proportion of the recommended DLT sizes from all three manufacturers was incompatible with individual patient's lower airway dimensions.

The benefits of dissecting inferior pulmonary ligament (IPL) during upper lobectomy using video-assisted thoracoscopic surgery (VATS) for early-stage lung cancer remains controversial. This study evaluates the effect of IPL dissection by comparing the lung volume, bronchial angle, and bronchial tortuosity of the left lower lobe (LLL) during VATS upper lobectomy. Medical records of all patients who underwent VATS left upper lobectomy for early-stage lung cancer were evaluated. Patients were divided into group P (preservation) and group D (dissection). Pre- and post-surgery lung volumes, bronchial angles (angle 1: axial angulation, angle 2: vertical angulation), and bronchial tortuosity (curvature index of the left main bronchus) were measured using computed tomography images for comparison. Forty patients were included in each group. Patient characteristics such as age, gender, body mass index, and smoking status, and preoperative lung volume, bronchial angles, and tortuosity were not significantly different between the two groups, and there was no statistically significant difference in the axial and vertical angulations, however, the change in pre- and postoperative bronchial tortuosity (0.03 ± 0.03 vs. 0.06 ± 0.03) and lung volume (−558.1 ± 410.0 mL vs. −736.3 ± 382.7 mL) showed a significant difference (p &lt, 0.001 and p = 0.04, respectively). Preservation of IPLs during left upper lobectomy may be beneficial for LLL expansion and induces less movement and positional change in the left main bronchus.

Tracheal diverticulum is observed in 1%-4% of the population, however, multiple tracheal diverticula are a rare occurrence. In this paper, we present a 75-year-old male, who was referred to a computed tomography-scan of the neck, chest, abdomen, and pelvis because of an unintended weight loss, fatigue, and a smoking history of 60 pack-years. A definitive cause for the symptoms was not found, however as an incidental finding, the patient was diagnosed with multiple tracheal diverticula along the back wall of trachea and left main bronchus. Despite the rare occurrence, it is important to recognize multiple tracheal diverticula in the diagnostic process, because of the possibility of either removing the diverticula or initiating prophylactic actions to prevent complications such as empyema and pneumomediastinum.

Primary tracheobronchial lipoma is an extremely rare entity, the diagnosis of which is often missed initially. Cases are generally diagnosed late after initial treatment for asthma and bronchitis. We report a case of a 42-year-old man with a left main bronchus lipoma that caused near-total obstruction. The lipoma was treated by bronchoscopic resection with an electrosurgical snare and cryoablation.

Wheezing is often occurred in infants and young children with respiratory infections. For children with recurrent wheezing, after controlling their wheezing, they should be alert to rare diseases. Here, We report a case of wheezing following the application of the patent ductus arteriosus occlusion device ADOII (AGA Medical Corporation, Golden Valley,MN) with the occlusion device pressing against the inner diameter of the adjacent left main bronchus. After the pressure end of the occluder was removed, the child’s wheezing was effectively relieved

OBJECTIVE: Minimally invasive esophagectomy (MIE) has been widely applied for the treatment of esophageal carcinoma. It is much less invasive, as it avoids employing a transthoracic procedure. BACKGROUND: MIE via transcervical and transhiatal approaches has been adopted in our center. In this approach, with the assistance of single-port techniques or robotic-assisted surgical systems, the esophagus is mobilized under visualization, which is followed by the removal of esophageal and mediastinal lymph nodes. METHODS: Increasing the surgical space by mediastinal insufflation or by elevation of the sternum with a hook may improve intraoperative identification of tissues and facilitate intraoperative mobilizations. The procedure can be performed simultaneously via both cervical and abdominal approaches without the need for intraoperative turning of the patient, which shortens the operative time. Also, there is no need for thoracotomy or single-lung ventilation, which avoids disturbance to the respiratory and circulation systems. CONCLUSIONS: Suitable instruments, especially state-of-the-art energy instruments, facilitate surgical separation and hemostasis. This surgical procedure has become increasingly sophisticated over the past decade, and its modular operation has been widely recognized. The feasible place of the neck-esophageal hiatus rendezvous is on the left main bronchus around the subcarinal region. Here we describe the technical features, key steps, and necessary precautions of this minimally invasive surgery for esophageal carcinoma.

Sleeve resection and double-barreled reconstruction are very rarely adopted for peripheral bronchial tumors. This surgical procedure was used for a carcinoid tumor in the bifurcation of the left upper and lower lobe bronchi. Bronchoplasty was accomplished by suturing the upper and basal bronchi together and anastomosing them to the left main bronchus. The techniques for double-barreled reconstruction described in this report obtained a successful result. These manipulations may be applicable to resection of other bronchial and tracheal bifurcations.

We report the case of a 4-year-old boy with a neuromucoepidermoid carcinoma of the left main bronchus. Complete resection of the carcinoma and reconstruction of the carina between lower and upper lobe by means of an end-to-end anastomosis was performed via a left-sided thoracotomy.

OBJECTIVES Obesity is a serious disorder that may lead to numerous difficulties in endotracheal tube (ETT) management. This study investigated the potential of tracheal ultrasound (TUS) for the accurate confirmation of the ETT position in obese patients. METHODS A total of 68 obese patients undergoing tracheal intubation were enrolled in this study from January 2017 to June 2018. All patients received auscultation and TUS to evaluate the ETT position, which was ultimately verified by bronchoscopy. A correct position of the ETT was defined as placement at the trachea, whereas placement at the right/left main bronchus was classified as an incorrect position. RESULTS We found 58 correct placements of the ETT at the trachea, 8 incorrect placements at the right main bronchus, and 2 incorrect placements at the left main bronchus. Compared with auscultation, TUS showed higher accuracy (85.29% versus 67.65%; P = .005), sensitivity (84.48% versus 67.24%; P = .005), and specificity (90.00% versus 70.00%; P

Resumo Justificativa Os tubos endotraqueais de duplo lumen (Double‐lumen tubes – DLTs) para intubacao seletiva esquerda tem sido amplamente usados em procedimentos toracicos, esofagicos, vasculares e mediastinais para proporcionar a separacao dos pulmoes. Com a falta de diretrizes claras, os anestesiologistas geralmente selecionam os tubos com base em sua experiencia com os tubos endotraqueais de duplo lumen de 35 e 37 Fr, os mais comumente usados. Nossa hipotese foi que os pacientes com um bronquio principal esquerdo de menor comprimento ( Metodos No total, 360 pacientes submetidos a intubacao seletiva esquerda mediante o uso de tubo de duplo lumen foram incluidos no estudo entre setembro de 2014 e agosto de 2015. Idade, sexo, altura, peso e doenca de base foram registrados, junto do tipo de procedimento cirurgico e os episodios de dessaturacao. Alem disso, a largura da traqueia e a largura e comprimento do bronquio esquerdo foram medidos por meio de tomografia computadorizada. Resultados Os pacientes com comprimento do bronquio principal esquerdo inferior a 40 mm, submetidos a intubacao seletiva esquerda com tubos endotraqueais de duplo lumen, tiveram incidencia significativamente maior de dessaturacao (odds ratio – OR: 8,087) durante a ventilacao monopulmonar. Outros fatores relacionados aos pacientes e identificados como risco de desenvolver hipoxemia foram diabetes mellitus (OR: 5,368), cirurgia de colapso direito (OR: 4,933) e IMC (OR: 1,105). Conclusoes Identificamos que os pacientes com comprimento do bronquio principal esquerdo inferior a 40 mm apresentam grande chance de dessaturacao, principalmente se outros fatores de risco para dessaturacao estiverem presentes.

Background: Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (