Tracheobronchial variations evaluated by multidetector computed tomography and virtual bronchoscopy

Introduction The tracheobronchial tree exhibits a wide range of variations. The purpose of this study is the investigation of the frequency and multidetector tomographic (MDCT) findings of anatomical variations of the main bronchi and of the lobar bronchi, as well as the detection of abnormal bronchi originated from the trachea, in subjects without severe bronchial pathology. Materials and methods About 872 consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar reconstructions, maximum intensity projections and volume-rendered images, as well as virtual bronchoscopy, were evaluated for the detection of main bronchial variations. Various kinds of bronchial variations and anomalies, such as tracheal bronchus, accessory cardiac bronchus, bronchus hypoplasia and bronchial origin anomalies, were documented. Results In 872 subjects, the overall frequency of main bronchus variations is 2.52% (22/872). More specifically, tracheal bronchus were found in eight cases (0.9%), accessory cardiac bronchus was found in one case (0.1%), hypoplasia was found in one case (0.1%) and bronchial origin anomalies were found in 10 cases (1.14%). Conclusion The display of tracheobronchial variations is of clinical importance first because they are related to infections and, sometimes, malignancies and second in preoperative or in cases of bronchoscopic procedures. In our study, the commonest variation was the tracheal bronchus. MDCT and virtual bronchoscopy can depict tracheobronchial variations accurately and can be served as an alternative to bronchoscopy in certain cases of possible bronchial anomaly.