Unusual Navigation Bronchoscopy Pathway of an Accessory Right Upper Lobe Bronchus

A. Alraiyes1, M. Elrifai2, W. S. Jaber3;

Author address: 

1Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States, 2Department of Medicine, Cleveland Clinic, Cleveland, OH, United States, 3Medicine, CTCA, Phoenix, AZ, United States.

Abstract: 

Introduction:Electromagnetic navigation bronchoscopy (ENB) helps in navigating and the diagnosis of solitary lung nodules by creating a virtual (GPS) pathway implemented from the patient CT-chest. The system help driving through the third to the fifth branching of the bronchial tree. We are presenting a case of a solitary lung nodule for a patient with a congenital airway anomaly known as accessory right upper lobe bronchus that generate directly from the right wall of the trachea.
Case discerption: 66 years-old man with history of myelodysplasitc syndrome and recent diagnosis of AML. The patient plan of treatment to undergo an allogeneic stem cell transplant. The patient had history of lung adenocarcinoma in left upper lobe treated with chemotherapy radiation therapy of the following left upper lobectomy. The patient was cancer free till the evaluation of stem cell transplant. The CT chest showed a left upper lobe nodule (figure). Due to the location and the vascular structure the CT guided biopsy was contraindicated. The patient evaluated for ENB and upon case planning, the virtual bronchoscopy mapping demonstrate the pathway through an accessory right upper lobe bronchus generated from the right wall of the trachea and leading to the RUL nodule. ENB performed and the diagnosis demonstrates Aspergillus fumigatus. The patient got treatment and the lung nodule disappeared on a follow up CT chest 4 months post treatment. And patient underwent allogeneic stem cell transplant.
Discussion Electromagnetic navigation bronchoscopy a recent technology that prove to help in detection and diagnosis of solitary lung nodules. In our case we present the ability of the ENB system to detect a congenital airway anomaly known as (tracheal bronchus or pig bronchus) which an accessory right upper lobe bronchus that generate directly from the right wall of the trachea. The ENB system mapping developed a virtual pathway using the tracheal bronchus to lead to the right upper lobe apical 14 mm lung nodule. The diagnosis obtained using the ENB system and there was no pneumothorax or bleeding complications.

Tables: 

2018

abstract No: 

A6438 / P636

Full conference title: 

The American Thoracic Society Conference 2018
    • ATS 2018