Incidental left main bronchus obstruction during left-sided double-lumen tube intubation of a patient with an unrecognized tracheal bronchus: A case report

INTRODUCTION: Tracheal bronchus is a right-sided anomalous bronchus arising from the trachea above the main carina and occurs in 0.1% to 2% of the general population. CASE PRESENTATION: We present a case of left main bronchus obstruction during a left-sided double-lumen tube intubation in a patient with an unrecognized tracheal bronchus. After the intubation, to confirm the position of the tube, we observed what we believed was the carina with a fiberoptic bronchoscope, but it was a site between the tracheal bronchus and the right main bronchus. Thus, a right-sided intubation was performed, and the left main bronchus was obstructed with a bronchial cuff. As a result of the inappropriate ventilation, peak inspiratory pressure was elevated and arterial oxygen saturation decreased. CONCLUSION: Anesthesiologists should keep in mind the possibility of anatomical variation in the large airways, and bronchoscopy should be accompanied by cautious auscultation and confirmation of the division of the bronchus.