Implications of a tracheal bronchus in a patient with thymoma.

1. Departamento de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España. 2. Departamento de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España. A 68-year-old woman with myasthenia gravis underwent a CT scan of the chest, which revealed a 4-cm solid mass in the anterior mediastinum, consistent with a thymoma (Figure 1). A type II tracheal bronchus, arising 3 cm above the carina, was incidentally detected on the CT scan (Figure 2). The patient was scheduled for elective surgery (thoracoscopy). An endobronchial blocker was inserted through a rigid bronchoscope and deployed in the left main bronchus for ventilation of the right lung. A 9-mm cuffed oral tracheal tube was placed above the offset of the tracheal bronchus in order to properly ventilate all zones of the right lung. The thoracic surgeons successfully resected the anterior mediastinal thymoma via a left thoracoscopic approach.