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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 857-858
Accessory cardiac bronchus: A rare congenital anomaly of the tracheobronchial tree

Dept.Of Radiodiagnosis, Ruby Hall Clinic, Pune-411001, India

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Date of Submission22-Aug-2006
Date of Acceptance10-Oct-2006

How to cite this article:
Atre A L, Joshi A, Joseph J, Tandon A, Sangle P. Accessory cardiac bronchus: A rare congenital anomaly of the tracheobronchial tree. Indian J Radiol Imaging 2006;16:857-8

How to cite this URL:
Atre A L, Joshi A, Joseph J, Tandon A, Sangle P. Accessory cardiac bronchus: A rare congenital anomaly of the tracheobronchial tree. Indian J Radiol Imaging [serial online] 2006 [cited 2021 Jan 18];16:857-8. Available from:

   Introduction Top

An accessory cardiac bronchus (ACB) is a "supernumerary bronchus arising from the inner wall of the right main bronchus or intermediate bronchus opposite to the origin of the right upper lobe bronchus [1]."

Most patients with an accessory cardiac bronchus are asymptomatic. The diagnosis is made easily on MDCT with minimum intensity projection and reformatted images.

   Case report Top

A 70-year-old man presented with history of cough and weight loss. The HRCT scan showed a localized area of air density medial to bronchus intermedius on axial images (Fig 1).

Reconstructed images in the coronal plane (Fig 2) demonstrate the blind-ending anomalous bronchus. Minimum intensity projection (Fig 3) and reconstructed images (Fig 4) showed an anomalous bronchus (arrow) arising from the medial aspect of the intermediate bronchus. Area of bronchiectasis in other lung segments also evident.

   Discussion Top

An accessory cardiac bronchus is a true supernumerary anomalous bronchus that may ventilate an accessory lobe [2]. It arises from the medial wall of the bronchus intermedius prior to the origin of the apical segmental bronchus of the right lower lobe and usually before the origin of the middle lobe bronchus. The accessory cardiac bronchus has a round orifice and is directed caudally, toward the pericardium. It may be a short, blind-ending structure or may be a longer, branching bronchus. It is lined by normal bronchial mucosa and has cartilage within its walls, which distinguishes it from an acquired fistula or diverticulum [3].

The bronchus progresses conically for 1-5 cm in a caudal direction toward the pericardium, paralleling the intermediate bronchus. Most accessory cardiac bronchi have a blind extremity, but imaging and anatomic studies have demonstrated that some develop into a series of small bronchioles, which may end in vestigial or rudimentary bronchiolar parenchymal tissue, cystic degeneration, or a ventilated lobulus [4],[7]. An abnormal pulmonary artery was observed in few cases.

Most patients with an accessory cardiac bronchus are asymptomatic. Symptomatic patients may present with recurrent infections or hemoptysis [5].

Some associated anomalies are reported in the literature, including right or left tracheal bronchus, coexistence of two accessory cardiac bronchus, and bronchiectasis [6],[7].

   Conclusion Top

Recognition of accessory cardiac bronchus is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients.

   References Top

1.Brock RC. The anatomy of the bronchial tree London, England: Oxford University Press, 1946.   Back to cited text no. 1    
2.Jackson GD, Littleton JT. Simultaneous occurrence of anomalous cardiac and tracheal bronchi: a case report. J Thorac Imaging 1988; 3:59-60.  Back to cited text no. 2    
3.McGuinness G, Naidich DP, Garay SM, Davis AL, Boyd AD, Mizrachi HH. Accessory cardiac bronchus: CT features and clinical significance. Radiology 1993; 189:563-566.  Back to cited text no. 3  [PUBMED]  
4.Ghaye B, Kos X, Dondelinger RF. Accessory cardiac bronchus: 3D CT demonstration in nine cases. Eur Radiol 1999; 9:45-48.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Mangiulea VG, Stinghe RV. The accessory cardiac bronchus: bronchologic aspect and review of the literature. Dis Chest 1968; 54:35-38.   Back to cited text no. 5    
6.Beigelman C, Howarth NR, Chartrand-Lefebvre C, Grenier P. Congenital anomalies of tracheobronchial branching patterns: spiral CT aspects in adults. Eur Radiol 1998; 8:79-85.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Benoit Ghaye, MD, David Szapiro, MD, Jean-Marc Fanchamps, MD and Robert F. Dondelinger, MD Congenital Bronchial Abnormalities Revisited. Radiographics 2001; 21:105-119.  Back to cited text no. 7    

Correspondence Address:
A L Atre
Dept.Of Radiodiagnosis, Ruby Hall Clinic, Pune-411001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.32367

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  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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