Ｏｂｊｅｃｔｉｖｅ　To analyze the tubing misplacement in double lumen bronchial intubation with computerized tomography (CT) for optimization of the procedure.　Methods　This study enrolled 87 patients subjected to major chest surgery with double lumen bronchial intubation for double lung ventilation. For each case, detailed information of bronchial intubation was collected with CT, including size of tubing, anatomical properties of trachea and bronchi, localization of double lumen endobronchial tubing. In some cases, tracheal endoscope was also performed.　Results　In 87 cases, the trachea of 27 cases deviated from normal positions or had aberrant shapes. In 13 of these 27 cases, the right, but not left, bronchial intubation was successful, while in 14 others, the left, but not right, bronchial intubation was successful. The other 60 cases had normal trachea. In 49 of these patients, left bronchial intubation was successful, and in other 11 patients, the right, but not left, bronchial intubation was successful. The correct placement of tubing is influenced by anatomy of trachea, bronchi and their junctions, including the diameters of bronchi, the angle between bronchus and the lower half of trachea, the angle between the longitudinal axis of trachea and that of the chest, the structure of the interface between proximal openings of right and left bronchi and the lower end of the trachea.　Conclusions　The anatomical complexity of trachea, bronchi, and their junctions are the major factors affecting the probability of the tubing misplacement in double lumen bronchial intubation. The guidance of simultaneous CT analysis may be an applicable strategy to avoid the misplacement.