A 2 year old boy admitted with recurrent respiratory tract infection for evaluation of active chest infection. Multislice computed tomography of chest was done which showed no evidence of active infection, but there was an incidental finding of tracheal trifurcation (volume rendered reconstruction showed two bronchi [long white arrow and arrow head] arising from the trachea on right side and left main bronchus [short arrow], and on virtual bronchoscopy inset two bronchi [long white arrow and arrow head] and left main bronchus [short arrow]).
Tracheal trifurcation is an extremely rare anomaly in which the trachea divides into three main stem bronchi rather than two, with two main bronchi supplying the right lung and one supplying the left lung.
Patients usually are asymptomatic and it is detected incidentally on imaging. Some patients may present with recurrent respiratory tract infection and may progress to bronchiectasis and chronic bronchitis.
It is important to identify this anatomical variant in patients requiring tracheal intubation.