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Right Upper Lobe Bronchoscopy

As an intensivist and cardiothoracic anesthesiologist, bronchoscopy is an incredibly common procedure I perform in the ICU (from in front of the patient) and OR (from behind the patient). A small camera on the end of a flexible tube is sent down an indwelling endotracheal or tracheostomy tube to visualize the airway, suction secretions, etc. Less often, I’ll do “awake bronchs” using topical anesthetics and IV sedation in patients without secure airways.

To help orient me, I first locate the right upper lobe (RUL) which normally has a characteristic trifurcation of the anterior, apical, and posterior segments. This is often referred to as the “Mercedes-Benz symbol” (see the overlay in the image). Once I successfully identify the RUL, I proceed down the bronchus intermedius and assess the right middle and lower lobes followed by a left-sided airway exam.

Understanding airway anatomy is important to help localize pathology and communicate findings to my consultant colleagues. See my full post on airway anatomy in the

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