To the Editor:—
Hagihira et al. 1reported the usefulness of a new double-lumen endobronchial tube specially designed for patients with a short right mainstem bronchus. Using x-ray data, they outlined that Japanese patients have, on average, a shorter right mainstem bronchus than American patients. We would caution against such x-ray measurements because of the spatial orientation of the main bronchi. This is particularly important when the left mainstem bronchus diameter is measured to choose an appropriate double-lumen tube. As the left mainstem bronchus is oblique through the horizontal plane, it is necessary to perform a multiplane reconstruction of the tracheobronchial tree using transverse, sagittal, and coronal tomodensitometric slices to obtain a strictly orthogonal slice of the left mainstem bronchus.2Such precautions are mandatory to prevent mismeasurement.
*Hôpital Foch, Suresnes, France. firstname.lastname@example.org