PMC8371316_01
(A) Right main bronchus wall with conical cleft-like protrusion (black arrow). (B) Anteroposterior angiography of BBF. (C) Lateral angiography of BBF.
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F1
The 3D-CT reconstruction showed that the wall of the right main bronchus has a conical cleft-like protrusion with the end pointing downward last time (Figure 1A). It can be seen that the contrast medium is connected to the left hepatic duct through the esophageal hiatus, and the contrast medium sequentially fills the left intrahepatic bile duct, the right intrahepatic bile duct, the common hepatic duct, the common bile duct, the gallbladder, and the duodenum (Figures 1B,C).
The pediatric endobronchial blocker system.
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F2
A multiport airway adapter (Tappa, Common type, EBT0105) was used to connect endotracheal intubation (Figure 2).
(A) Abnormal opening of the tracheal carina (white arrow). (B) Endobronchial blocker enter into the trachea. (C) Endobronchial blocker enter into the fistula. (D) The endobronchial blocker was inflated and fixed after entering the fistula.
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F3
An abnormal opening was found at the level of the tracheal carina, and yellow secretions could be seen at the opening (Figure 3A). With the assistance of an electronic fiber bronchoscope, the endobronchial blocker was inserted into the fistula (Figures 3B-D).
Video-assisted thoracoscopic surgery to cut and suture the fistula. (A) CBBF was detected. (B) Free CBBF. (C) Ligation of CBBF. (D) CBBF was cut and sutured.
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F4
A 6-mm-diameter fistula was found at the beginning of the right main bronchus below the tracheal carina (Figure 4A). The fistula was fully exposed and the whole course of the fistula was free intrathoracic (Figure 4B). After double ligation with No. 10 mousse thread at both ends (Figure 4C), the fistula was double clamped with a hemolock clamp, and the fistula was removed with an ultrasonic knife (Figure 4D).