Abstract：
BACKGROUND: Tracheal trifurcation is an uncommon and often unknown type of anomalous tracheobronchial arborization, characterized by three main bronchi originating at the level of the carina. Diagnosis is important due to its clinical implications.
OBJECTIVE: To highlight the anatomical, clinical and diagnostic aspects of tracheal trifurcation by reporting our experience and reviewing the literature.
METHODS: We retrospectively evaluated pediatric patients referred to our institution from January 2018 to May 2020 with a diagnosis of tracheal trifurcation. All patients underwent chest radiographs, computed tomography (CT) (with/without dynamic airway scanning) and bronchoscopy. Clinical and anatomical data were collected.
RESULTS: Three patients with tracheal trifurcation were identified (1 female, median age: 7.6±0.4 months). All had associated anomalies: two had tetralogy of Fallot, one with esophageal atresia/tracheoesophageal fistula and one with an atrioventricular septal defect, and the other had skeletal ciliopathy. Chest radiographs were not diagnostic for tracheal trifurcation. Bronchoscopy could not fully evaluate the trachea and main bronchi in two cases. CT detected tracheal trifurcation in all of the patients and also demonstrated other lung parenchymal and congenital anomalies. Two of the three main bronchi were directed to the right lung in all cases. Ostial stenosis of either the central (two patients) or right upper bronchus (one patient) was present. No signs of tracheobronchomalacia were found.
CONCLUSIONS: Tracheal trifurcation is rare and often associated with additional disorders, such as other tracheobronchial anomalies, cardiovascular defects or esophageal malformations, responsible for clinical manifestations and earlier detection. Bronchoscopy is often used for diagnosis, but is invasive and may be incomplete or inconclusive, while CT allows for a noninvasive and correct diagnosis, while also highlighting additional findings in the thorax.
OBJECTIVE: To highlight the anatomical, clinical and diagnostic aspects of tracheal trifurcation by reporting our experience and reviewing the literature.
METHODS: We retrospectively evaluated pediatric patients referred to our institution from January 2018 to May 2020 with a diagnosis of tracheal trifurcation. All patients underwent chest radiographs, computed tomography (CT) (with/without dynamic airway scanning) and bronchoscopy. Clinical and anatomical data were collected.
RESULTS: Three patients with tracheal trifurcation were identified (1 female, median age: 7.6±0.4 months). All had associated anomalies: two had tetralogy of Fallot, one with esophageal atresia/tracheoesophageal fistula and one with an atrioventricular septal defect, and the other had skeletal ciliopathy. Chest radiographs were not diagnostic for tracheal trifurcation. Bronchoscopy could not fully evaluate the trachea and main bronchi in two cases. CT detected tracheal trifurcation in all of the patients and also demonstrated other lung parenchymal and congenital anomalies. Two of the three main bronchi were directed to the right lung in all cases. Ostial stenosis of either the central (two patients) or right upper bronchus (one patient) was present. No signs of tracheobronchomalacia were found.
CONCLUSIONS: Tracheal trifurcation is rare and often associated with additional disorders, such as other tracheobronchial anomalies, cardiovascular defects or esophageal malformations, responsible for clinical manifestations and earlier detection. Bronchoscopy is often used for diagnosis, but is invasive and may be incomplete or inconclusive, while CT allows for a noninvasive and correct diagnosis, while also highlighting additional findings in the thorax.
摘要：
背景：气管三分叉是一种罕见且通常未知的异常气管支气管阻塞类型，特征在于起源于隆突水平的三个主要支气管。由于其临床意义，诊断很重要。
目的：为了突出解剖学，临床和诊断方面的气管三分叉通过报告我们的经验和回顾文献。
方法：我们回顾性评估了2018年1月至2020年5月转诊至我们机构的诊断为气管三分叉的儿科患者。所有患者都接受了胸片，计算机断层扫描（CT）（有/无动态气道扫描）和支气管镜检查。收集临床和解剖学数据。
结果：确定了3例气管三分叉患者（1例女性，中位年龄：7.6±0.4个月）。所有人都有相关的异常:两个人患有法洛四联症，一个患有食管闭锁/气管食管瘘，一个患有房室间隔缺损，另一个有骨骼纤毛病.胸部X光片不能诊断气管三叉。2例支气管镜检查不能完全评估气管和主支气管。CT在所有患者中均检测到气管三分叉，并显示其他肺实质和先天性异常。在所有情况下，三个主要支气管中的两个都指向右肺。存在中央（两名患者）或右上支气管（一名患者）的口狭窄。没有发现气管支气管软化的迹象。
结论：气管三分叉是罕见的，通常与其他疾病有关，例如其他气管支气管异常，心血管缺陷或食道畸形,负责临床表现和早期检测。支气管镜检查通常用于诊断，但是是侵入性的，可能是不完整的或不确定的，虽然CT可以进行无创和正确的诊断，同时还突出了胸部的其他发现。
目的：为了突出解剖学，临床和诊断方面的气管三分叉通过报告我们的经验和回顾文献。
方法：我们回顾性评估了2018年1月至2020年5月转诊至我们机构的诊断为气管三分叉的儿科患者。所有患者都接受了胸片，计算机断层扫描（CT）（有/无动态气道扫描）和支气管镜检查。收集临床和解剖学数据。
结果：确定了3例气管三分叉患者（1例女性，中位年龄：7.6±0.4个月）。所有人都有相关的异常:两个人患有法洛四联症，一个患有食管闭锁/气管食管瘘，一个患有房室间隔缺损，另一个有骨骼纤毛病.胸部X光片不能诊断气管三叉。2例支气管镜检查不能完全评估气管和主支气管。CT在所有患者中均检测到气管三分叉，并显示其他肺实质和先天性异常。在所有情况下，三个主要支气管中的两个都指向右肺。存在中央（两名患者）或右上支气管（一名患者）的口狭窄。没有发现气管支气管软化的迹象。
结论：气管三分叉是罕见的，通常与其他疾病有关，例如其他气管支气管异常，心血管缺陷或食道畸形,负责临床表现和早期检测。支气管镜检查通常用于诊断，但是是侵入性的，可能是不完整的或不确定的，虽然CT可以进行无创和正确的诊断，同时还突出了胸部的其他发现。
