3 A Variant Airway Anatomy Prepared By BRONCHATLAS

3 A: Variant Airway Anatomy Prepared By BRONCHATLAS© www. Bronchoscopy. org 5/26/17 All Rights Reserved, 2017 1

Epiglottis Thin tongue-like 5/26/17 Thick Omega-shaped All Rights Reserved, 2017 2

Cartilage protuberance trachea Patient without respiratory symptoms 5/26/17 All Rights Reserved, 2017 3

Lobar and segmental anatomy From Oho and Matsukawa 5/26/17 Left Right BI, All Rights Reserved, 2005 4

Enlarged arytenoids Open 5/26/17 Closed All Rights Reserved, 2017 5

Airway secretions ■ Airway secretions are usually clear and frothy. Cricoid cartilage (superior aspect) 5/26/17 All Rights Reserved, 2017 6

Small, round cricoid region in woman of small stature 5/26/17 All Rights Reserved, 2017 7

Also seen in the airway wall Anthrocotic pigment 5/26/17 Bronchial glands/ mucosal pits All Rights Reserved, 2017 8

Enlarged bronchial pits 5/26/17 All Rights Reserved, 2017 9

Mucosal swelling Anterior swelling Swelling on spur Biopsies all normal. No subsequent pathology noted 5/26/17 All Rights Reserved, 2017 10

Prominent longitudinal elastic bundles Posterior wall of bronchus 5/26/17 All Rights Reserved, 2017 11

Anthrocosis With hyperemia 5/26/17 With stenosis and edema All Rights Reserved, 2017 12

Tracheal cartilage variants Saber sheath 5/26/17 Bony protuberance All Rights Reserved, 2017 13

More tracheal variants V-shaped trachea 5/26/17 U-shaped trachea All Rights Reserved, 2017 14

Cartilaginous spur Left main bronchus With pale overlying mucosa The Patient had bronchitis 5/26/17 All Rights Reserved, 2017 15

Tracheal bronchus orifice is almost two centimeters above the main carina, along Right lateroposterior tracheal wall. 5/26/17 All Rights Reserved, 2017 16

Tracheal bronchus orifice at level of carina and at entrance to the Right main bronchus 5/26/17 All Rights Reserved, 2017 17

Carina shapes A B C Normal, but different. Note slight infolding (normal during expiration) in photo B 5/26/17 All Rights Reserved, 2017 18

Normal variants of Right upper lobe segmental bronchial anatomy Box-like Quadripartite upper lobe 5/26/17 Linear quadripartite configuratlion RUL All Rights Reserved, 2017 Pyramid-like Quadripartite RUL upper lobe 19

Right middle lobe bronchus variant Immediate bipartite configuration medial segment of RML bronchus 5/26/17 Lateral segment RML bronchus All Rights Reserved, 2017 20

Right lower lobe bronchus variant Small medial basal segment RB 7) 5/26/17 All Rights Reserved, 2017 21

Bipartite variants Right upper lobe bronchus 5/26/17 Right lower lobe bronchus All Rights Reserved, 2017 22

Subapical segment of the Right lower lobe bronchus Mediobasal segment Superior segment Subapical segment Middle lobe bronchus 5/26/17 All Rights Reserved, 2017 23

Left lower lobe bronchus with right sided configuration Left lower lobe basal pyramid Medial basal segment LB 7 5/26/17 All Rights Reserved, 2017 24

Linear configuration of left lower lobe basal segments LB 6 LB 10 LB 8 5/26/17 All Rights Reserved, 2017 25

Step by Step© BRONCHATLAS© & You. Tube Instructional videos This presentation is part of a multidimensional competency-oriented curriculum for Flexible Bronchoscopy. Our goal is to eliminate patient suffering caused by unequal physician expertise and on-the-job training. 5/26/17 All Rights Reserved, 2017 26

All efforts are made by Bronchoscopy International to maintain currency of online information. Multimedia presentations and videos can be cited as: Bronchoscopy International: Bronch. Atlas©, an Electronic On-Line Multimedia Slide Presentation. http: //www. Bronchoscopy. org/Bronchatlas/htm. Published 2017 (Please add “Date Accessed”). BRONCHATLAS© Thank you 5/26/17 All Rights Reserved, 2017 27

www. Bronchoscopy. org 28