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Dynamic CT Evaluation of the Central Airways in Patients Undergoing Tracheoplasty for Tracheobronchomalacia

¹ Instituto de Radiologia, Hospital das Clinicas da Faculdade de Medicina da USP, São Paulo, Brazil.
² Instituto Israelita de Ensino e Pesquisa Albert Einstein, Department of Radiology, Albert Einstein Hospital, São Paulo, Brazil.
³ Department of Cardiothoracic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215.
⁴ Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.

View larger version (136K): [in a new window]   Fig. 1A. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia: comparison of pre- and postoperative CT images. Preoperative end-inspiratory CT image obtained before surgery shows trachea has biconvex ("fishmouth") shape at end-inspiration. Incidental note is made of paraseptal emphysema (arrow).

View larger version (117K): [in a new window]   Fig. 1B. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia: comparison of pre- and postoperative CT images. On preoperative dynamic expiratory CT image, trachea shows marked collapse at dynamic expiration, acquiring lunate shape.

View larger version (135K): [in a new window]   Fig. 1C. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia: comparison of pre- and postoperative CT images. Postoperative end-inspiratory CT image obtained after tracheoplasty shows trachea has normal horseshoe shape. Emphysema (arrows) is also noted.

View larger version (118K): [in a new window]   Fig. 1D. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia: comparison of pre- and postoperative CT images. Postoperative dynamic expiratory CT image shows that horseshoe configuration persists despite mild degree of collapse.

View larger version (70K): [in a new window]   Fig. 2A. —58-year-old woman (patient 4 in Table 1) with tracheobronchomalacia. Unenhanced CT image obtained at end inspiration before tracheoplasty shows normal thickness of posterior airway wall at level just below carina.

View larger version (68K): [in a new window]   Fig. 2B. —58-year-old woman (patient 4 in Table 1) with tracheobronchomalacia. Unenhanced CT image obtained at end inspiration after tracheoplasty shows diffuse posterior wall thickening (arrow). This finding is related to plication of posterior airway wall with reinforcing Marlex mesh.

View larger version (63K): [in a new window]   Fig. 3A. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia (same patient as shown in Fig. 1A, 1B, 1C, 1D). Unenhanced CT image obtained 4 days after tracheoplasty shows large amount of fluid and soft-tissue density (arrow) surrounding trachea, corresponding to postoperative fluid and blood.

View larger version (52K): [in a new window]   Fig. 3B. —62-year-old man (patient 1 in Table 1) with tracheobronchomalacia (same patient as shown in Fig. 1A, 1B, 1C, 1D). Unenhanced CT image obtained 45 days after tracheoplasty shows postsurgical soft-tissue density has significantly decreased, with residual posterior airway wall thickening related to procedure (arrow).

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