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Tracheobronchomalacia

Dynamic Airway Evaluation with Multidetector CT

¹ Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH 44106.
² Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, Cleveland, OH 44106.

View larger version (127K): [in a new window]   Fig. 1A. —35-year-old woman with history of sarcoidosis and asthma who presented with persistent dyspnea. Pulmonary function tests showed flattening of expiratory limb of flow-volume loop, suggestive of upper airway collapse. Axial CT scan of trachea obtained during inspiration shows normal-caliber trachea.

View larger version (131K): [in a new window]   Fig. 1B. —35-year-old woman with history of sarcoidosis and asthma who presented with persistent dyspnea. Pulmonary function tests showed flattening of expiratory limb of flow-volume loop, suggestive of upper airway collapse. Axial CT scan of trachea obtained during dynamic expiration shows crescentic bowing of posterior membranous trachea consistent with tracheobronchomalacia (arrows).

View larger version (131K): [in a new window]   Fig. 2A. —12-year-old boy with history of recurrent childhood infections and persistent barking cough. Pulmonary function tests showed expiratory flattening of flow-volume loop, suggestive of upper airway collapse. Axial CT scan obtained at level of carina during inspiration shows normal caliber of mainstem bronchi.

View larger version (118K): [in a new window]   Fig. 2B. —12-year-old boy with history of recurrent childhood infections and persistent barking cough. Pulmonary function tests showed expiratory flattening of flow-volume loop, suggestive of upper airway collapse. Axial CT scan obtained at level of carina during dynamic expiration shows marked narrowing (arrows) of trachea and mainstem bronchi.

View larger version (105K): [in a new window]   Fig. 3A. —19-year-old man with Hunter's syndrome, cough, and recurrent dyspnea in whom indirect laryngoscopy (not shown) suggested laryngomalacia with soft-tissue infiltration of upper airways. Because of patient's clinical status, family refused bronchoscopy. Axial CT scan of trachea obtained during expiration shows marked crescentic narrowing of tracheal lumen. Note soft-tissue infiltration of mediastinum and trachea (arrows), consistent with mucopolysaccharide deposition.

View larger version (34K): [in a new window]   Fig. 3B. —19-year-old man with Hunter's syndrome, cough, and recurrent dyspnea in whom indirect laryngoscopy (not shown) suggested laryngomalacia with soft-tissue infiltration of upper airways. Because of patient's clinical status, family refused bronchoscopy. Shaded-surface display image of central airways in posterolateral projection shows diffuse narrowing of trachea and bronchi (arrows).

View larger version (106K): [in a new window]   Fig. 4A. —57-year-old woman with suspected congenital lobar emphysema of right lung. Axial CT scan obtained during dynamic expiration at level of bronchus shows extensive emphysematous change within right lung, with extensive air-trapping and mediastinal shift due to hyperinflated right lung.

View larger version (130K): [in a new window]   Fig. 4B. —57-year-old woman with suspected congenital lobar emphysema of right lung. Virtual bronchoscopic image obtained at level of bronchus intermedius during full inspiration shows mildly narrowed but patent right middle (M) and lower (L) lobe bronchi.

View larger version (122K): [in a new window]   Fig. 4C. —57-year-old woman with suspected congenital lobar emphysema of right lung. Virtual bronchoscopic image obtained during dynamic expiration shows marked narrowing of right middle lobe bronchus (straight arrow) with complete collapse of lower lobe orifice (curved arrow). These findings were not clearly appreciated on axial CT images (not shown) but were confirmed on bronchoscopy.

View larger version (110K): [in a new window]   Fig. 5A. —52-year-old man with idiopathic tracheobronchomalacia and persistent cough after undergoing stenting of mainstem bronchi. Fiberoptic bronchoscopic image obtained before stenting shows marked expiratory collapse of central airways (arrows), which is consistent with tracheobronchomalacia.

View larger version (106K): [in a new window]   Fig. 5B. —52-year-old man with idiopathic tracheobronchomalacia and persistent cough after undergoing stenting of mainstem bronchi. Axial CT scan obtained at level of upper lobe bronchus during inspiration shows persistent narrowing of proximal portion of upper lobe bronchus (arrow) distal to endobronchial stent. Note position of bronchial stents. Position of bronchial stents are identified by arrowheads.

View larger version (95K): [in a new window]   Fig. 5C. —52-year-old man with idiopathic tracheobronchomalacia and persistent cough after undergoing stenting of mainstem bronchi. Axial CT scan obtained during dynamic expiration shows focal collapse of proximal right upper lobe bronchus (straight arrow). Note hyperlucency of right upper lobe, consistent with air-trapping of affected lung (curved arrows). Arrowheads = bronchial stents.

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