Tracheal Bronchus Associated With Unilateral Absence of Pulmonary Artery and Recurrent Pneumonia

Tracheal bronchus or pig bronchus is a rare congenital lung anomaly .In this condition, an ectopic bronchus arises from the lateral wall of the trachea, more commonly from right side. Although pig bronchus is usually asymptomatic, however in some patients it is presented with recurrent pneumonia and segmental atelectasis. The patient was a five-month-old female referred to the clinic because of pneumonia with inappropriate response to antibacterial treatment and previous history of recurrent pneumonia. On chest X-ray, she had reduced volume right lung with mediastinal shift to the right side. Thorax computed tomography scan (CT scan) revealed pneumonitis. On bronchoscopy, there was no foreign body, but purulent exudates and fibrin were observed in her right lung and possibility of tracheal bronchus was not proposed. Although axial views of CT scan did not determine any anatomic anomaly, the coronal view reconstruction of her first CT scan revealed tracheal bronchus above the carina on the right side. The images of axial cuts of CT scan re-inspect one more time; it was interesting that it had some evidence of tracheal bronchus. Recurrent pneumonia in right upper lobe sensitized physicians about the possibility of congenital anomalies particularly tracheal bronchus and coronal view reconstruction of CT scan should be requested.