Prevalence and Anatomical Characteristics of Major Tracheobronchial Anomalies: A Comprehensive Review and Meta-Analysis
Keywords:
Tracheobronchial Anomalies, Tracheal Bronchus, Accessory Cardiac Bronchus, Meta-analysis, Computed TomographyAbstract
Background: Tracheobronchial anomalies are rare congenital airway variations that complicate management, predispose to recurrent pulmonary infections, and are associated with congenital heart disease. Though case reports and regional cohorts exist, prevalence estimates and anatomical descriptors are fragmented. Objective: To systematically evaluate and synthesize existing literature to determine the prevalence and describe the anatomical characteristics of major congenital tracheobronchial anomalies, with the goal of enhancing understanding and improving diagnostic accuracy in clinical practice. Methodology: A systematic search of PubMed, Embase, Scopus, and Web of Science (2015–2023) was conducted to identify studies reporting tracheobronchial anomalies. Following PRISMA guidelines, 22 studies met eligibility criteria. Data on prevalence, anatomical classification, laterality, morphometric descriptors, and associations with congenital anomalies were extracted. Random-effects meta-analysis was used to calculate pooled prevalence, with heterogeneity and publication bias assessed by I² statistics and funnel plots. Results: From 22,460 screened records, 22 studies comprising >35,000 patients were included. The pooled prevalence of tracheobronchial anomalies was 1.0% (95% CI 0.8–1.3%), with higher rates in pediatric bronchoscopy cohorts (2.0%) and congenital heart disease populations (2.6%). More than 95% of tracheal bronchi were right-sided, with displaced Type II bronchi most common. Morphometric descriptors included an average take-off distance of 5–10 mm from the carina and luminal diameters of 4–6 mm. Conclusion: Tracheobronchial anomalies, though uncommon, have significant clinical implications. Routine recognition on CT and bronchoscopy is essential, particularly in patients undergoing thoracic or cardiac surgery. Standardized classification and systematic airway evaluation in at-risk populations will enhance diagnostic accuracy, inform perioperative planning, and improve patient outcomes.References
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