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Right main bronchus

Main bronchi · About 25 degrees About 2.5 cm Under azygos arch

Wider, shorter (about 2.5 cm) and more vertical (about 25 degrees from the tracheal axis) than the left, so it is the near-straight continuation of the trachea. It passes beneath the arch of the azygos vein to the hilum at T5, gives off the upper lobe bronchus and continues as the bronchus intermedius.

Traced from the start

  1. Trachea
  2. Right main bronchus

Detail

Dimensions
About 2.5 cm long, about 25 degrees from the midline, larger calibre than the left
Relations
Azygos vein arches over it from behind; right pulmonary artery lies first in front and then below, so the upper lobe bronchus arises above the artery (eparterial)
Branches
Right upper lobe bronchus about 2 cm from the carina, then continues as the bronchus intermedius to the middle and lower lobe bronchi
Supply
Right bronchial artery (usually from the third right posterior intercostal); vagal and sympathetic fibres from the pulmonary plexus; generation 1 in the Weibel model

When it goes wrong

Inhaled foreign body (peanut, tooth) in an adult or a child over about 3 years

Lodges on the right because the bronchus is wider, more vertical and the carina sits left of the midline: unilateral wheeze, reduced breath sounds, air trapping on an expiratory film from a ball-valve effect, or right lower lobe collapse

Endotracheal tube advanced too far

Right main bronchial intubation: absent left breath sounds, left lung collapse, hypoxaemia, high airway pressures and risk of right-sided barotrauma; withdraw the tube

Child under about 3 years

The two main bronchi leave the trachea at nearly equal angles, so foreign bodies lodge on the left almost as often as the right

Aspiration of gastric contents

Right-sided pneumonia; the segment involved depends on posture at the time (see the lower lobe segmental bronchi)

Practise this structure

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