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Hello everyone.

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I'm going to go over some tricky and challenging pediatric cases.

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Um,

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it took some time and we had to use multiple modalities to come

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to conclusion in most of these cases.

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So I hope you enjoy the challenges and, uh, let's get started.

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All right, so, um, to give a background,

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this 10 month old came with repeated infections of the right upper lobe and we

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were asked to do a,

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a CT scan and I'm going to show some X-ray.

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So here is the x-ray from second February,

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you can see the right lobe is well expanded.

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Then on third February,

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this patient had some sis in the right upper lobe.

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Seventh February it got worse,

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and on 12th February it resolved. And, uh, in the past,

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uh, six months, this patient had multiple episodes of similar findings.

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So with that background, we got the CT done,

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which I'm going to scroll the aha

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images first in the lung window.

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And I'm going to go slowly from the top of the trachea

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to the Corona

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Bronchos intermediates,

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right middle low brotus and the right lower low bronchus.

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I'm going to show the Corona as well.

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So here is the trachea Corona, right bronchus left bronchus,

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and you can

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see there is some anomalous Brocas there.

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So let's go to our next slide.

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What is the most likely diagnosis? Awesome.

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So we saw the trachea Brocas.

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This bronchs arises directly from the trachea or main bronchi.

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The bronchus ab bronchus actually can be called pig bronchus or

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so is Brocas because the bronchi arise

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from directly from the trachea in, in the pigs.

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So trac bronchia can be supernumerary, can be displaced,

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they can be associated with different anomalies.

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That's why it is important for us to recognize as pediatric cardiologist,

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the variants in the anatomy of the trachea bronchia,

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there can be associated with partial anomalous pulmonary venous accessory lobes

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and uh, they can actually supply directly to the azygos. Lobe in itself is a,

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a separate lobe and has a separate anatomy and blood supply as well as

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a separate,

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Um, fissure in itself. It can be associated with congenital cysts,

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which are the lung cyst, which look simple cyst.

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We are not talking about c a m and they can be associated with partial

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agensis of bronchos. They can present with repeated infections,

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bronchiectasis, smop, lower and emphysema, cpa, uh,

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strider and respiratory distress.