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Original Research: CRITICAL CARE MEDICINE |

Measurement of Left Mainstem Bronchus Using Multiplane CT Reconstructions and Relationship Between Patient Characteristics or Tracheal Diameters and Left Bronchial Diameters*

Philippe Olivier, MD; David Hayon-Sonsino, MD; Jean Paul Convard, MD; Pierre-Antoine Laloë, MD; Marc Fischler, MD
Author and Funding Information

*From the Groupe des Anesthésistes Réanimateurs de l’Hôpital Privé d’Antony (Dr. Olivier) and the Department of Radiology (Dr. Convard), Hôpital Privé d’Antony, Antony, France; and the Department of Anesthesiology (Drs. Hayon-Sonsino, Laloë, and Fischler), Hôpital Foch, Suresnes, France.

Correspondence to: Marc Fischler, MD, Service d’Anesthésie, Hôpital Foch, 40 rue Worth, 92151 Suresnes, France; e-mail: m.fischler@hopital-foch.org



Chest. 2006;130(1):101-107. doi:10.1378/chest.130.1.101
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Study objectives: To measure the tracheal diameters (TDs) [transverse (Tr) TD, and anteroposterior (AP) TD] and left main bronchus diameters (LBDs) [Tr and AP] using multiplane CT scan reconstructions with a tridimensional correction of the declination. To evaluate the relationship between clinical variables and CT scan diameters of the tracheobronchial tree. To aid in the selection of a double-lumen tube of appropriate size.

Design: Prospective observational study.

Setting: Private and university hospitals.

Patients: A total of 206 patients (105 women and 101 men) undergoing a CT scan for medical investigations or preoperative evaluation.

Intervention: No intervention.

Measurements and results: TDs and LBDs are greater in men (p < 0.001). The Tr-TD is smaller than AP-TD for men (p < 0.001). The Tr-LBD is greater than AP-LBD in both sexes (p < 0.001). In men, height, Tr-TD, and AP-TD are predictive factors for Tr-LBD, while Tr-TD and AP-TD are the only predictive factors for AP-LBD. In women, Tr-TD and AP-TD are the only predictive factors for Tr-LBD and AP-LBD. The smallest LBD (ie, the lesser of the Tr-LBD or the AP-LBD [called the smallest LBD]) is the Tr-LBD in 25.2% of the cases. The mean (± SD) ratio of the smallest LBD/Tr-TD is 0.70 ± 0.14 for men and 0.65 ± 0.12 for women. The estimated (Est) LBD is calcuted using this ratio. The mean value for Est-LBD minus the smallest LBD is 1.6 ± 1.3 mm, and this difference is < 1 mm in 40% of male patients and 39% of female patients.

Conclusions: In conclusion, the left main bronchus is most often elliptic, and the smallest LBD cannot be accurately evaluated using patient characteristics or a ratio from TD.

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