Tracheal Take-Off in an Elderly Patient: A Pig Bronchus or a Separate Right Upper Lobe?

Tracheobronchial anomalies such as tracheal bronchus, or "pig bronchus," are extremely rare congenital airway anomalies but are clinically important variants. Distinguishing these from other bronchial variants, such as duplicate or accessory bronchi, can be challenging yet important for diagnosis and clinical management. A pig bronchus is a congenital anomaly in which an aberrant bronchus arises directly from the trachea, most commonly supplying the right upper lobe. Although often asymptomatic, it may predispose individuals to recurrent chest infections due to impaired mucociliary clearance. We report the case of a 76-year-old male with no prior comorbidities who was referred for evaluation of recurrent chest infections requiring multiple courses of antibiotics. Flexible bronchoscopy revealed a right-sided tracheal bronchus arising approximately 2 cm above the carina. A contrast-enhanced CT thorax confirmed the presence of a displaced bronchus supplying the right upper lobe. The patient was managed conservatively with airway clearance strategies and remains under follow-up with reduced infection frequency. This case raises a diagnostic dilemma between a classical pig bronchus and a separate right upper lobe bronchus. While both entities may have similar clinical presentations, differentiating them is important for understanding pathophysiology, planning interventions, and guiding patient management, and should be considered in the differential diagnosis of recurrent infections-even in elderly patients.