Tracheobronchial Angle in Children - Three-dimensional Computed Tomography Based Measurements

Bronchus, Pediatric Airway

Accurate understanding of tracheobronchial anatomy is important for application of various airway maneuvers in anesthesiology in children. Majority of pediatric anesthesia textbooks state that the anatomic orientation of the right main bronchus is at less acute angle to the vertical tracheal axis, although these angles tend to be similar in children younger than three years of ageThe visualization of the air column in tracheobronchial tree in a three-dimensional (3D) CT-based image is clear with the air column simulating the actual internal shape of the airway. We hypothesize that RBA and LBA are unequal as children like adults are prone to right mainstem intubation We have measured the right and left bronchial angle using the three dimensional CT based images of the air column in the tracheobronchial tree.

Accurate understanding of tracheobronchial anatomy is important for application of various airway maneuvers in anesthesiology in children. Significant variations and discrepancies in the reported tracheobronchial angles are found in literature. Various imaging modalities ranging from chest x-ray to helical computed tomography (CT) have been used for measuring the tracheobronchial angles in children and the results are varied with some studies reporting equal angles \[2016\] while others reporting right bronchial angle to be smaller than left bronchial angle \[Kubota\]. The visualization of the air column in tracheobronchial tree in a three-dimensional (3D) CT-based image is clear with the air column simulating the actual internal shape of the airway. The highest quality medical-grade (3D) images are obtained using CT data \[Uchida M\]. Computed tomography (CT) is considered the current gold standard for airway measurements as the air-tissue interface is better delineated by CT imaging \[Reinhardt\]. We hypothesize that RBA and LBA are unequal as children like adults are prone to right mainstem intubation We have measured the right and left bronchial angle using the three dimensional CT based images of the air column in the tracheobronchial tree.

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