Newly Published
Images in Anesthesiology  |   April 2020
Bronchus Intermedius Compression from Idiopathic Thoracic Scoliosis
Author Notes
  • From the Department of Anesthesia, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Correspondence: Address correspondence to Dr. Atteri: Meenakshi.atteri@cchmc.org
Article Information
Images in Anesthesiology / Respiratory System
Images in Anesthesiology   |   April 2020
Bronchus Intermedius Compression from Idiopathic Thoracic Scoliosis
Anesthesiology Newly Published on April 13, 2020. doi:https://doi.org/10.1097/ALN.0000000000003311
Anesthesiology Newly Published on April 13, 2020. doi:https://doi.org/10.1097/ALN.0000000000003311
A 14-year-old female with adolescent idiopathic thoracic dextroscoliosis, moderate restrictive lung disease on pulmonary function testing, and persistent cough presented for posterior spinal fusion. After induction, flexible bronchoscopy revealed moderate to severe obstruction of the bronchus intermedius (image A, white arrow and Supplemental Digital Content, http://links.lww.com/ALN/C349). The preoperative computed tomography scan demonstrates how the thoracic spine (image B, black dotted arrow) compresses the bronchus intermedius (image B, black arrow).
Idiopathic scoliosis can have significant effects on the respiratory system, including decreased lung volumes, impaired respiratory mechanics, decreased lung and chest wall compliance, and even pulmonary hypertension or respiratory failure if the curvature is severe.1  Although restrictive lung disease is the most prevalent abnormality on pulmonary function testing in idiopathic scoliosis, obstructive or mixed lung disease has also been reported.1,2  Specifically, bronchus intermedius obstruction is thought to occur when the natural thoracic kyphotic curve is lost as a result of dextroscoliosis.3  This leads to the thoracic spine pushing forward onto the bronchus intermedius, resulting in external compression and obstruction.