European Journal of Radiology 40 (2001) 50 – 53 Virtual endoscopy in the diagnosis of an adult double tracheal bronchi case G.C. Kagadis a , V. Patrinou b , C.P. Kalogeropoulou c , D. Karnabatidis c , T. Petsas c , G.C. Nikiforidis a , D. Dougenis b, * a Department of Medical Physics, Patras Uniersity School of Medicine, Rion, 26500 Patras, Greece b Department of Cardiothoracic Surgery, Patras Uniersity School of Medicine, Rion, 26500 Patras, Greece c Department of Radiology, Patras Uniersity School of Medicine, Rion, 26500 Patras, Greece Received 31 October 2000; received in revised form 5 February 2001; accepted 12 February 2001 Abstract We report a case of ipsilateral double tracheal bronchi supplying a tracheal lobe in a 42-year-old man, who presented with a 10-year history of recurrent respiratory infections. Diagnosis was established by chest computed tomography (CCT), virtual endoscopy and bronchoscopy. Both bronchi were surgically resected along with the right upper lobe of the lung and the associated tracheal lobe. To our knowledge, this is the first report of ipsilateral double tracheal bronchi in the adult life to be diagnosed and treated on the basis of modern radiological techniques and especially virtual endoscopy findings. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Helical-CT; Trachea-CT; 3-D imaging; Virtual endoscopy www.elsevier.com/locate/ejrad 1. Introduction Three-dimensional (3-D) reconstructed CT images for tracheobronchial tree evaluation improve our per- ception of image features and information, which, though contained in classic transverse CT slices, can now be better displayed. Thus, spatial relationships of pathological regions and surrounding structures can easily be figured out [1]. Problems resulting from pa- tients’ breathing are practically absent due to the small scanning times of synchronous spiral Computed To- mographers that allow the whole scanning to be done in one single breath hold. Virtual endoscopy is a useful approach for assessing 3-D CT images. Like other 3-D reconstruction techniques, virtual endoscopy does not add information to that provided by axial CT images but is helpful to the referring physicians in the 3-D image evaluation and treatment planning [2]. Tracheal bronchus (TB) is a rare congenital anomaly, originating more commonly from the right wall of the trachea above the carina. Its incidence ranges between 0.1 and 5% [3]. The clinical importance of the lesion is that TB may give rise to respiratory symptoms due to repeated pulmonary infections. An extremely rare, par- ticularly in adult life, case of a double TB associated with an intralobar tracheal lobe is presented, which was diagnosed by virtual endoscopy. 2. Case report A 42-year-old man presented with a 10-year history of repeated hospitalizations for recurrent right upper lobe pneumonia. Chest radiography revealed a right upper lobe opacity (Fig. 1A). A computed tomography of the chest demonstrated one blunt TB and another supplying tracheal pulmonary lobe with intralobar po- sition and post inflammatory signs and fibrosis (Fig. 1B). It also confirmed the trifurcation of the right upper bronchus (Fig. 1C). There were no signs of malignancy. The patient data sets were taken in a Somatom Plus 4 * Corresponding author. Tel.: +30-61-999779; fax: +30-61- 993984. E-mail address: ddougen@med.upatras.gr (D. Dougenis). 0720-048X/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0720-048X(01)00312-6