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Tracheomalacia Incidentally Detected on CT Pulmonary Angiography of Patients with Suspected Pulmonary Embolism

¹ Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
² Present address: Department of Diagnostic Radiology, School of Medicine, Keio University, Tokyo, Japan.

OBJECTIVE. The aim of this study was to determine the frequency of tracheomalacia incidentally detected on CT pulmonary angiography in patients with suspected pulmonary embolism.

MATERIALS AND METHODS. CT records of 163 consecutive patients imaged with CT pulmonary angiography for suspected pulmonary embolism were retrospectively reviewed at our institution. The patients underwent CT pulmonary angiography with three different types of CT scanners. All images were visually assessed by two thoracic radiologists for excessive collapse of the trachea and the main bronchi. The cross-sectional area of the lumen at the site of maximal collapse of the airway was measured, and the percentage of luminal narrowing was calculated by comparing it with the cross-sectional area of the airway lumen at an adjacent area without collapse. We defined tracheomalacia as a 50% or greater decrease in tracheal lumen.

RESULTS. Sixteen (10%) of 163 patients showed evidence of tracheomalacia (seven men, nine women; age range, 41–95 years; mean age, 72 years). The most common presenting symptom was shortness of breath, which was observed in 13 (81%) of 16 patients. Known causes of tracheomalacia were found in 15 (94%) of 16 patients, prior intubation was confirmed in 12 patients, and history of asthma or chronic obstructive pulmonary disease was observed in five patients.

CONCLUSION. Tracheomalacia is a relatively common incidental finding on CT pulmonary angiography studies. The central airways, as well as pulmonary vasculature, should be reviewed carefully for clinical interpretation in patients with suspected pulmonary embolism. Paired expiratory–inspiratory CT is recommended if patients present with known causes of tracheomalacia such as prior intubation, chronic obstructive pulmonary disease, or asthma.

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