Detection of trachea branch angles using computerizedtomography, the relationship of these angles with age and gender

Objective: The aim of our study is to determine the tracheobronchial branching angles inpediatric and adult populations by using multislice CT and MinIP technique, which is a non- invasive method. It is necessary to bring the data obtained for the anatomical knowledge of the tracheobronchial system to the literature and to use interventional fiberoptic bronchoscopy during various airway devices, intubation, airway reconstruction and tracheobronchial tumor resection. Therefore, it was aimed to guide before diagnosis, treatmentand invasive procedures in areas such as anesthesia, thoracic surgery and pulmonary physiology. Material and Method: Our study included reasons that disrupt the anatomy and physiology of the tracheobronchial system, patients with pneumothorax or pneumomediastinum as a result of trauma, patients with pathology that may cause changes in the mediastinum, patients with musculoskeletal deformity, diaphragmatic cases with hernia weren't included in the study. Evaluations were made in the axial plane.The measurements in the lung parenchyma window in the coronal plane. In the coronal plane, the right main bronchus-left main bronchus angle, the right upper lobe bronchus-intermedius bronchus angle, the right middle lobe bronchus-right lower lobe bronchus angle, and the left upper lobe bronchus. The left lower lobe bronchial angle was measured. Results: The study population was 753 pediatrics (49.5%) (mean age: 13.4±4.3 years; range: 1-18 years) and 758 adults (mean age: 54.3±17.3; range: 19-94 years) patients. Right- left main coronal, right upper-intermedius coronal and left upper-lower coronal levels did not differ in pediatric and adult patient groups, right middle-lower coronal levels were found to belower in the pediatric group compared to the adult group (36.9±12.2 vs. 42 .4±12.3; p<0.001). ix Presence of atelectasis, presence of emphysema and bronchiectasis in the adult group was foundto be higher. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls, right upper-intermedius coronal, left upper-lower coronal, and right middle coronal -lower coronal levels did not differ significantly by gender in the pediatric group. The proportion of patients with the presence of atelectasis, emphysema and bronchiectasis did not differ significantly in the pediatric group by gender. In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9±12.9 vs 75.8±14.7; p<0.001), right upper-intermedius coronal, leftupper-lower coronal and right middle coronal levels, lower coronal levels did not differ significantly according to gender in the adult group. Presence of atelectasis did not differ significantly in the adult group according to gender. Men were found to have more emphysema (13.3% vs. 4.5%; p<0.001) and bronchiectasis (4.9% vs. 1.9%; p=0.027) than women. Conclusion: Our study is the first study in the literature to measure the angle values of the tracheobronchial system using the multislice CT and to have the largest patient population including both pediatric and adult demographic data. The study data will not only be a guide during invasive procedures, but may also guide future studies on cadavers or with imaging methods.