Tracheal bronchus.

A 65-year-old white woman was seen because of 2 episodes of mild hemoptysis complicating a persistent cough. Her medical history was positive for 8 years of mild shortness of breath and an indirect exposure to asbestos. Her review of systems was unremarkable and physical examination showed normal vital signs and blood oxygen saturation of 97% on room air. Air entry was normal and there were no wheezes, crackles, or rhonchi. No lymph nodes were palpated and there was no clubbing. Pulmonary function testing showed a mild restriction. For hypertension and coronary artery disease she was taking furosemide and atenolol. A high-resolution computed tomogram of the chest was entirely normal. Flexible bronchoscopy was performed to investigate the etiology of the hemoptysis. No sources of bleeding or endobronchial lesions were found. Bronchoalveolar lavage was negative for culture and cytology. However, the patient was found to have an accessory bronchial take-off on the right side of the trachea 1–2 cm above the main carina, leading to the apical segment of the right upper lobe (Figs. 1, 2, and 3). The right main bronchus morphology was normal. The right upper-lobe bronchus had only 2 segments: the posterior and the anterior. At a 6-month follow-up visit the patient’s hemoptysis had not recurred.