Published online Apr 28, 2023. doi: 10.4329/wjr.v15.i4.118
Peer-review started: December 27, 2022
First decision: February 21, 2023
Revised: February 28, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 28, 2023
The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology.
To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method.
Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured.
The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 ± 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 ± 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3° ± 13.7° (59.6°-87°) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6° ± 12.9° vs 71.2° ± 13.9°, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9° ± 12.9° vs 75.8° ± 14.7°, P < 0.001).
Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.
Core Tip: This study is one of the rare studies with the highest number of patient population and measurement values in the literature measuring the branching angles of the tracheobronchial tree using the minimum intensity projection technique with multislice computed tomography in pediatric and adult populations. In this study, a wide variety of branching angles of the tracheal bronchial tree, which were not reported in the literature, were reported. Anatomical knowledge of the tracheobronchial system is essential during the use of interventional fiberoptic bronchoscopy during various airway devices, intubation, airway maneuvers. These results guide interventional procedures and offer new methods for future studies.