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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Right lower lobe bronchus variant Small medial basal segment RB7) 5/26/17 All Rights Reserved, 2017

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

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

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

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

BRONCHATLAS© Step by Step© & YouTube 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

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