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Asian Cardiovasc Thorac Ann 2005;13:399
© 2005 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Left Bronchial Isomerism

Hon-Chi Suen, MD, Farris Jackson, MD1, W Mark Breite, MD1, Alfred Shaplin, MD2, James A Junker, MD2, Bill B Daily, MD

Department of Cardiothoracic Surgery
1 Department of Pulmonology
2 Department of Radiology, Jefferson Memorial Hospital, Crystal City, MO, USA

For reprint information contact: Hon-Chi Suen, MD Tel: 1 618 233 5722 Fax: 1 618 233 7069 Email: HSUEN{at}earthlink.net, Cardiothoracic Surgery Associates, S.C., 12B Park Place, Swansea, IL 62226, USA.

A 42-year-old white female presented with incidental chest X-ray finding of a right lower lobe (RLL) nodule (not shown) which later turned out to be a granuloma. CT chest in Figure 1Go showed that the right main bronchus (RMB) bifurcated at the same level as the left main bronchus (LMB) and the right upper lobe (RUL) bronchus was ventral to the right main pulmonary artery (RPA) instead of being in the usual eparterial position. Bronchoscopic findings confirmed left bronchial isomerism. Figure 2AGo is a view of the lower trachea and carina showing no evidence of tracheal bronchus. Figure 2BGo is a view of the RMB showing that the RUL orifice was absent from its usual location of the lateral wall of RMB. Figure 2CGo is a view of the distal RMB showing that it bifurcated into the RUL and RLL, and the right middle lobe (RML) orifice arose from within the RUL bronchus (analogous to the lingula on the left). The branching pattern of the right bronchial tree was the mirror image of the normal left bronchial tree as shown in Figure 2DGo (LUL=left upper lobe, LLL=left lower lobe).



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  		Figure 1. (Left) CT chest showing that the right main bronchus (RMB) bifurcated at the same level as the left main bronchus (LMB) and the right upper lobe (RUL) bronchus was ventral to the right main pulmonary artery (RPA) instead of being in the usual eparterial position.

 


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  		Figure 2. Lower trachea and carina (A). Right main bronchus (RMB) (B). Distal RMB (C). Left bronchial tree (D).

 





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Bill B Daily
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