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Diffuse Abnormalities of the Trachea and Main Bronchi

¹ All authors: Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710.

View larger version (74K): [in a new window]   Fig. 1A. —Relapsing polychondritis in 49-year-old woman. CT scan (soft-tissue window settings, 10-mm collimation) shows diffuse tracheal wall thickening (arrows).

View larger version (139K): [in a new window]   Fig. 1B. —Relapsing polychondritis in 49-year-old woman. Inspiratory CT scan (lung window settings, 10-mm collimation) reveals thickened anterior cartilaginous portion of bronchi (arrows) and normal lung parenchyma.

View larger version (111K): [in a new window]   Fig. 1C. —Relapsing polychondritis in 49-year-old woman. Expiratory CT scan (lung window settings, 10-mm collimation) shows abnormal collapse of bronchi with left lung air trapping.

View larger version (107K): [in a new window]   Fig. 2. —Amyloidosis in 27-year-old woman with progressive dyspnea. CT scan (1.5-mm collimation) obtained at level of left main bronchus depicts diffuse circumferential thickening of bronchial walls (arrows). Note high-attenuation regions in bronchial wall, likely representing calcification. Transbronchial biopsy revealed amyloidosis.

View larger version (101K): [in a new window]   Fig. 3. —Sarcoidosis in 30-year-old woman. Coronal minimum-intensity-projection image obtained from CT scan (3-mm collimation) reveals diffuse narrowing of left main bronchus (straight arrows) and its bifurcating branches, surrounded by conglomerate mediastinal and left hilar lymphadenopathy. Note occlusion of left upper lobe bronchus (curved arrows) by same process. L = left main bronchus, r = right main bronchus.

View larger version (100K): [in a new window]   Fig. 4A. —Wegener's granulomatosis in 19-year-old man with dyspnea. CT scan (3-mm collimation) obtained at level of thyroid gland (T) reveals significant tracheal narrowing with diffuse circumferential soft-tissue thickening.

View larger version (46K): [in a new window]   Fig. 4B. —Wegener's granulomatosis in 19-year-old man with dyspnea. Lateral shaded-surface—display image obtained from CT scan (3-mm collimation) reveals diffuse narrowing of subglottic trachea (solid arrows) that extends 1.5 cm inferiorly from vocal cords. Note apparent airway discontinuity due to adducted vocal cords (open arrows). p = pyriform sinus.

View larger version (110K): [in a new window]   Fig. 5. —Wegener's granulomatosis in 33-year-old woman. Coronal minimum-intensity-projection image obtained from CT scan (3-mm collimation) delineates two focal strictures (arrows) in diffusely narrowed left main bronchus.

View larger version (81K): [in a new window]   Fig. 6A. —Tracheopathia osteochondroplastica in 75-year-old asymptomatic man. (Courtesy of CA Meyer, Indianapolis, IN) CT scan (10-mm collimation) obtained at level of transverse aorta reveals multiple calcified nodules arising from inner anterolateral wall of trachea. Posterior membranous portion of trachea (arrow) is spared. Note lymph node (n) is calcified, which was likely caused by prior histoplasmosis.

View larger version (97K): [in a new window]   Fig. 6B. —Tracheopathia osteochondroplastica in 75-year-old asymptomatic man. (Courtesy of CA Meyer, Indianapolis, IN) CT scan (lung window settings) shows diffuse mural nodules involving only cartilaginous portion of bronchi resulting in mild luminal narrowing.

View larger version (115K): [in a new window]   Fig. 7. —Tracheobronchial papillomatosis in 49-year-old woman with laryngeal papillomata. CT scan (10-mm collimation) reveals 6-mm intratracheal nodule consistent with tracheal papilloma (arrow). Tracheobronchial tree was diffusely studded with smaller papillomata.

View larger version (117K): [in a new window]   Fig. 8A. —Histoplasmosis in 45-year-old man with recurrent pneumonia in right lung. CT scan (3-mm collimation) shows significant narrowing of bronchus intermedius (straight arrow), adjacent soft-tissue mass, and heavily calcified subcarinal lymph node (curved arrow).

View larger version (127K): [in a new window]   Fig. 8B. —Histoplasmosis in 45-year-old man with recurrent pneumonia in right lung. Coronal oblique shaded-surface—display image obtained from CT scan (3-mm collimation) shows diffuse narrowing of bronchus intermedius (arrow). L = left main bronchus, R = right main bronchus.

View larger version (103K): [in a new window]   Fig. 9A. —Saber-sheath trachea in 64-year-old man with chronic obstructive pulmonary disease. Posteroanterior chest radiograph reveals diffuse narrowing of coronal diameter of intrathoracic trachea (straight arrows). Note that extrathoracic trachea is normal in diameter (curved arrow).

View larger version (117K): [in a new window]   Fig. 9B. —Saber-sheath trachea in 64-year-old man with chronic obstructive pulmonary disease. Lateral chest radiograph shows increased tracheal diameter throughout its intrathoracic course (arrows).

View larger version (118K): [in a new window]   Fig. 9C. —Saber-sheath trachea in 64-year-old man with chronic obstructive pulmonary disease. CT scan (10-mm collimation) obtained at thoracic inlet reveals that sagittal diameter—coronal diameter ratio of intrathoracic trachea exceeds 2:1. Tracheal walls are mildly thickened with ossification of tracheal rings.

View larger version (132K): [in a new window]   Fig. 10A. —Mounier-Kuhn's syndrome in 42-year-old man who presented with recurrent pneumonia. Posteroanterior chest radiograph shows marked tracheal (straight arrows) and bronchial enlargement (curved arrows).

View larger version (96K): [in a new window]   Fig. 10B. —Mounier-Kuhn's syndrome in 42-year-old man who presented with recurrent pneumonia. CT scan (8-mm collimation) reveals marked enlargement of main bronchi with corrugated appearance of anterior bronchial wall from mucosal prolapse through tracheal rings (arrow).

View larger version (84K): [in a new window]   Fig. 10C. —Mounier-Kuhn's syndrome in 42-year-old man who presented with recurrent pneumonia. CT scan (8-mm collimation) confirms marked enlargement of trachea (T), measuring 3.9x3.5 cm in diameter.

View larger version (107K): [in a new window]   Fig. 11. —Williams-Campbell syndrome in 27-year-old man with recurrent infection. Thin-section CT scan (1.5-mm collimation) shows varicoid and cystic central bronchiectasis associated with normal-caliber main bronchi.

View larger version (102K): [in a new window]   Fig. 12. —Traction tracheomegaly in 63-year-old man with prior history of tuberculosis. Posteroanterior chest radiograph shows severe upper lobe fibrosis resulting in displacement and dilatation of trachea (curved arrows) and main bronchi (straight arrows).

View larger version (119K): [in a new window]   Fig. 13. —Allergic bronchopulmonary aspergillosis in 41-year-old man with severe asthma. Thin-section CT scan (1.5-mm collimation) reveals central varicoid bronchiectasis (arrow).

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