Pediatric Congenital Tracheobronchial Variants and Their Clinical Significance for Endotracheal Intubation and Airway Management: A Scoping Review of Fetal, Neonatal, and Pediatric Cases.

Congenital tracheobronchial variants (CTBVs) may distort airway landmarks, alter carinal recognition, and complicate ventilation during pediatric endotracheal intubation. Although uncommon, these anomalies can create important peri-intubation risks that are often underrecognized. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. Using a Population-Concept-Context framework, we identified human case reports and small case series describing congenital tracheal or bronchial anomalies relevant to intubation, bronchoscopy, ventilation, or airway planning. Searches were performed in PubMed, Scopus, and Web of Science, with additional studies identified through manual searching. Sixty-six records were identified. After removal of one duplicate, 61 records from the database search were screened, 42 were excluded, and 23 full-text reports were assessed. Twenty studies were included, comprising 18 case reports and two small case series. Six studies described tracheal agenesis or atresia, four bronchial atresia, three tracheal bronchi, three bridge bronchi with or without pulmonary artery sling, and four bronchial isomerism or laterality defects. Cases ranged from 21 weeks of gestation to 15 years of age. Tracheal agenesis or atresia produced the most severe cannot-intubate presentations. Fixed stenotic lesions increased risks during tube passage and sizing, whereas distal anomalies more commonly mimicked selective intubation, mucus plugging, or refractory wheeze. CTBVs have important implications for pediatric airway management. Pre-intubation anatomical assessment and early bronchoscopic confirmation may reduce avoidable complications and support safer individualized airway planning.