An Assessment of the Tracheobronchial Branching Anomalies in 1000 Adult Patients: A Computed Tomography-based Population Study

Objective: The tracheobronchial tree has several anatomical variants, many of which are asymptomatic and are not identified until adulthood. This study demonstrated tracheobronchial branching anomalies in adult patients using chest computed tomography (CT).Methods: Thorax CT examinations of 1000 adult patients were retrospectively evaluated. Frequencies, localizations, and types of the tracheal diverticulum, tracheal bronchus, accessory cardiac bronchus, upper lobes, and right middle lobe branching anomalies, sub superior and supra superior bronchus, right and left isomerism, and situs inversus and bridging bronchus were evaluated.Results: Tracheobronchial branching anomalies were detected in 102 of 1000 patients (491 females, 509 males). An isolated anomaly was observed in 92 patients, whereas five patients had two separate anomalies. Preeparterial bronchi in 8 patients, left prehyparterial bronchi in 2 patients, right suprasuperior bronchi in 9 patients, right subsuperior bronchi in 33 patients, left subsuperior bronchi in 38 patients, and accessory cardiac bronchi in 7 patients were observed. A single right tracheal bronchus, posteparterial bronchus, right tracheal diverticulum, upwardly displaced middle lobe bronchus, and situs inverse were observed. Of the detected congenital tracheal bronchial anomalies, 11 were displaced and 82 were supernumerary.Conclusion: Radiological assessment of branching anomalies is crucial because of their potential clinical consequences. CT is a successful imaging method in the evaluation of tracheobronchial branching anomalies. Using lobe-based classification will facilitate the detection and classification of these anomalies.