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Multidetector CT Virtual Bronchoscopy to Grade Tracheobronchial Stenosis

Hanno Hoppe1, Beat Walder2, Martin Sonnenschein1, Peter Vock1 and Hans-Peter Dinkel1

1 Institute of Diagnostic Radiology, Inselspital, University of Berne, Freiburgstr. 20, CH-3010 Berne, Switzerland.
2 Department of Pneumonology, Inselspital, University of Berne, CH-3010 Berne, Switzerland.



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  		Fig. 1A. —50-year-old man with bronchial carcinoma of right upper lobe bronchus and tumor infiltration of right main bronchus and intermediate bronchus from lateral bronchial wall (arrows). Tumor occludes upper lobe bronchus. This figure illustrates so-called "multiview mode," in which workstation screen is split into four quadrants. Virtual bronchoscopic CT view down right main bronchus shows grade 1 stenosis caused by tumor occluding right upper lobe bronchus (arrow) growing into main and intermediate bronchi.

 


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  		Fig. 1B. —50-year-old man with bronchial carcinoma of right upper lobe bronchus and tumor infiltration of right main bronchus and intermediate bronchus from lateral bronchial wall (arrows). Tumor occludes upper lobe bronchus. This figure illustrates so-called "multiview mode," in which workstation screen is split into four quadrants. Axial CT image shows tumor (arrow). Axial CT is best suited for defining tumor's position relative to hilar and mediastinal structures.

 


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  		Fig. 1C. —50-year-old man with bronchial carcinoma of right upper lobe bronchus and tumor infiltration of right main bronchus and intermediate bronchus from lateral bronchial wall (arrows). Tumor occludes upper lobe bronchus. This figure illustrates so-called "multiview mode," in which workstation screen is split into four quadrants. Sagittal reformatted CT image offers little additional data about this patient. Arrow points to tumor occluding orifice of right upper lobe bronchus and protruding into main bronchial lumen.

 


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  		Fig. 1D. —50-year-old man with bronchial carcinoma of right upper lobe bronchus and tumor infiltration of right main bronchus and intermediate bronchus from lateral bronchial wall (arrows). Tumor occludes upper lobe bronchus. This figure illustrates so-called "multiview mode," in which workstation screen is split into four quadrants. Coronal reformatted CT image offers best anatomic orientation in this case because it shows tracheal bifurcation, intermediate bronchus, and occluded upper lobe bronchus (arrow) in one image.

 


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  		Fig. 2A. —50-year-old man with bronchial carcinoma of right upper lobe bronchus. Images from CT virtual bronchoscopy (A) and flexible bronchoscopy (B) obtained from identical viewing position in distal trachea show tumor laterally infiltrating right main bronchus and intermediate bronchus (arrow, A and B), producing grade 1 stenosis.

 


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  		Fig. 2B. —50-year-old man with bronchial carcinoma of right upper lobe bronchus. Images from CT virtual bronchoscopy (A) and flexible bronchoscopy (B) obtained from identical viewing position in distal trachea show tumor laterally infiltrating right main bronchus and intermediate bronchus (arrow, A and B), producing grade 1 stenosis.

 


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  		Fig. 3A. —65-year-old man with right-sided bronchial carcinoma. Images from CT virtual bronchoscopy (A) and flexible bronchoscopy (B) are identical endoscopic views obtained from distal trachea that provide example of grade 2 stenosis of right main bronchus (arrows, A and B) caused by extrinsic tumor compression by bronchogenic carcinoma.

 


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  		Fig. 3B. —65-year-old man with right-sided bronchial carcinoma. Images from CT virtual bronchoscopy (A) and flexible bronchoscopy (B) are identical endoscopic views obtained from distal trachea that provide example of grade 2 stenosis of right main bronchus (arrows, A and B) caused by extrinsic tumor compression by bronchogenic carcinoma.

 

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