B80-1-19 A Rare Airway Blueprint: Combined Bilateral Eparterial Displaced Bronchi and Accessory Lobation in an Adult
Abstract
Congenital tracheobronchial anomalies are identified in approximately 1% of the population, with displaced or supernumerary bronchi being particularly uncommon in adults. These anomalies are often asymptomatic but may predispose to recurrent respiratory infections, chronic cough, or airway obstruction, especially in individuals with underlying pulmonary or genetic conditions. We present a case of bilateral eparterial displaced bronchi with accessory lobation discovered during evaluation of persistent cough in a patient with Wolff-Parkinson-White (WPW) syndrome and heterozygous alpha-1 antitrypsin (A1AT) deficiency.
A 63-year-old male with WPW and heterozygous A1AT deficiency presented with a persistent non-productive cough and dyspnea for one week. He was initially treated at an urgent care center for presumed community-acquired pneumonia with doxycycline, albuterol, benzonatate, and prednisone without improvement. Subsequent evaluation by his primary care physician led to sequential courses of levofloxacin and moxifloxacin for five days each, with continued cough and wheezing despite frequent use of inhaled bronchodilators. He denied fever, chills, or recent hospital exposure. He was a lifelong non-smoker. Due to persistent symptoms despite three antibiotic regimens, bronchoscopy with bronchoalveolar lavage (BAL) was performed to evaluate for atypical infection. Bronchoscopy revealed a displaced eparterial bronchus arising from the left mainstem bronchus, bifurcating…
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