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Advanced Visualization of Airways with 64-MDCT: 3D Mapping and Virtual Bronchoscopy

Karen M. Horton1, Maureen R. Horton2 and Elliot K. Fishman1

1 Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St., JHOC 3253, Baltimore MD, 21287.
2 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.


Figure 1
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  		Fig. 1A —36-year-old woman with cough. Example of effect of rendering algorithm on luminal size. Volume-rendered 3D image of airway using translucent preset shows trachea measures 1.76 cm.

 

Figure 2
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  		Fig. 1B —36-year-old woman with cough. Example of effect of rendering algorithm on luminal size. Volume-rendered 3D image of airway using more opaque preset shows trachea measures 1.42 cm.

 

Figure 3
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  		Fig. 2A —45-year-old woman with cough. Endoluminal image shows trachea.

 

Figure 4
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  		Fig. 2B —45-year-old woman with cough. Endoluminal image shows carina.

 

Figure 5
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  		Fig. 2C —45-year-old woman with cough. Endoluminal image shows right upper lobe (RUL) bronchus.

 

Figure 6
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  		Fig. 2D —45-year-old woman with cough. Endoluminal image shows subsegmental branch of right lower lobe bronchus.

 

Figure 7
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  		Fig. 2E —45-year-old woman with cough. Coronal multiplanar reformation shows level of D. Arrow indicates subsegmental branch of right lower lobe bronchus.

 

Figure 8
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  		Fig. 3A —75-year-old man with chondrosarcoma metastatic to right hilum with encasement of carina and narrowing of bronchi (arrows). Axial CT scan.

 

Figure 9
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  		Fig. 3B —75-year-old man with chondrosarcoma metastatic to right hilum with encasement of carina and narrowing of bronchi (arrows). Coronal multiplanar reformation.

 

Figure 10
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  		Fig. 3C —75-year-old man with chondrosarcoma metastatic to right hilum with encasement of carina and narrowing of bronchi (arrows). Volume-rendered image.

 

Figure 11
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  		Fig. 4A —4-year-old boy with history of aortopexy performed to release congenital vascular compression of left mainstem bronchus. Patient had persistent stridor after surgery. CT scans show persistent narrowing of left mainstem bronchus (arrow), which is pinched between descending aorta and left pulmonary artery. Coronal multiplanar reformation.

 

Figure 12
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  		Fig. 4B —4-year-old boy with history of aortopexy performed to release congenital vascular compression of left mainstem bronchus. Patient had persistent stridor after surgery. CT scans show persistent narrowing of left mainstem bronchus (arrow), which is pinched between descending aorta and left pulmonary artery. Volume-rendered image.

 

Figure 13
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  		Fig. 4C —4-year-old boy with history of aortopexy performed to release congenital vascular compression of left mainstem bronchus. Patient had persistent stridor after surgery. CT scans show persistent narrowing of left mainstem bronchus (arrow), which is pinched between descending aorta and left pulmonary artery. Endoluminal image.

 

Figure 14
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  		Fig. 4D —4-year-old boy with history of aortopexy performed to release congenital vascular compression of left mainstem bronchus. Patient had persistent stridor after surgery. CT scans show persistent narrowing of left mainstem bronchus (arrow), which is pinched between descending aorta and left pulmonary artery. Axial image.

 

Figure 15
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  		Fig. 5A —77-year-old woman with Wegener's granulomatosis. CT scans show irregular thickening and narrowing of left mainstem bronchus (arrow) with partial left upper lobe atelectasis. Axial image with soft-tissue window.

 

Figure 16
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  		Fig. 5B —77-year-old woman with Wegener's granulomatosis. CT scans show irregular thickening and narrowing of left mainstem bronchus (arrow) with partial left upper lobe atelectasis. Axial image with lung window.

 

Figure 17
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  		Fig. 5C —77-year-old woman with Wegener's granulomatosis. CT scans show irregular thickening and narrowing of left mainstem bronchus (arrow) with partial left upper lobe atelectasis. Endoluminal image.

 

Figure 18
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  		Fig. 6A —75-year-old man with recurrent pneumonia. Lobular mass (arrows, B and C) arises from bronchus intermedius causing partial obstruction and atelectasis. Biopsy revealed atypical carcinoid. Axial CT scan.

 

Figure 19
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  		Fig. 6B —75-year-old man with recurrent pneumonia. Lobular mass (arrows, B and C) arises from bronchus intermedius causing partial obstruction and atelectasis. Biopsy revealed atypical carcinoid. Coronal multiplanar reformation CT scan.

 

Figure 20
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  		Fig. 6C —75-year-old man with recurrent pneumonia. Lobular mass (arrows, B and C) arises from bronchus intermedius causing partial obstruction and atelectasis. Biopsy revealed atypical carcinoid. Endoluminal image.

 

Figure 21
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  		Fig. 7A —50-year-old man with bronchogenic carcinoma. CT scans show extensive tumor involvement of mediastinum and pleura. Focal metastatic lesion (arrow) is present along right wall of trachea. Coronal multiplanar reformation.

 

Figure 22
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  		Fig. 7B —50-year-old man with bronchogenic carcinoma. CT scans show extensive tumor involvement of mediastinum and pleura. Focal metastatic lesion (arrow) is present along right wall of trachea. Volume-rendered image.

 

Figure 23
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  		Fig. 7C —50-year-old man with bronchogenic carcinoma. CT scans show extensive tumor involvement of mediastinum and pleura. Focal metastatic lesion (arrow) is present along right wall of trachea. Endoluminal image.

 

Figure 24
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  		Fig. 8A —10-year-old boy with wheezing and history of laryngeal papillomatosis. One-centimeter papilloma (arrow) is present at carina. Axial image.

 

Figure 25
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  		Fig. 8B —10-year-old boy with wheezing and history of laryngeal papillomatosis. One-centimeter papilloma (arrow) is present at carina. Volume-rendered image.

 

Figure 26
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  		Fig. 8C —10-year-old boy with wheezing and history of laryngeal papillomatosis. One-centimeter papilloma (arrow) is present at carina. Endoluminal image.

 

Figure 27
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  		Fig. 9A —63-year-old woman with chronic cough. CT scans show endobronchial lesion (arrow) partially obstructing left upper lobe bronchus. Axial image.

 

Figure 28
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  		Fig. 9B —63-year-old woman with chronic cough. CT scans show endobronchial lesion (arrow) partially obstructing left upper lobe bronchus. Endoluminal image.

 

Figure 29
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  		Fig. 10A —50-year-old man with chest pain. CT scans show incidental right tracheal diverticulum (arrow). Axial image.

 

Figure 30
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  		Fig. 10B —50-year-old man with chest pain. CT scans show incidental right tracheal diverticulum (arrow). Coronal multiplanar reformation.

 

Figure 31
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  		Fig. 10C —50-year-old man with chest pain. CT scans show incidental right tracheal diverticulum (arrow). Volume-rendered image.

 

Figure 32
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  		Fig. 11A —6-month-old boy with wheezing. CT scans show right tracheal bronchus (arrow). Coronal multiplanar reformation.

 

Figure 33
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  		Fig. 11B —6-month-old boy with wheezing. CT scans show right tracheal bronchus (arrow). Volume-rendered image with opaque airway.

 

Figure 34
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  		Fig. 11C —6-month-old boy with wheezing. CT scans show right tracheal bronchus (arrow). Volume-rendered image with radiolucent airway.

 

Figure 35
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  		Fig. 12A —73-year-old man who arrived in emergency department with shortness of breath and wheezing, remote history of right upper lobectomy for lung cancer, and recent history of bladder cancer managed with cystoprostatectomy 2 weeks previously. CT evaluation to rule out pulmonary embolism revealed filling defect (arrow) in right lower lobe bronchus not reported after initial review of axial images but later found on coronal multiplanar reformations. Bronchoscopy revealed aspirated food. Axial image.

 

Figure 36
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  		Fig. 12B —73-year-old man who arrived in emergency department with shortness of breath and wheezing, remote history of right upper lobectomy for lung cancer, and recent history of bladder cancer managed with cystoprostatectomy 2 weeks previously. CT evaluation to rule out pulmonary embolism revealed filling defect (arrow) in right lower lobe bronchus not reported after initial review of axial images but later found on coronal multiplanar reformations. Bronchoscopy revealed aspirated food. Coronal multiplanar reformation.

 

Figure 37
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  		Fig. 13A —49-year-old man with lung cancer obstructing left mainstem bronchus treated with stent placement. Stent (arrows) has migrated and protrudes into carina. Axial image.

 

Figure 38
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  		Fig. 13B —49-year-old man with lung cancer obstructing left mainstem bronchus treated with stent placement. Stent (arrows) has migrated and protrudes into carina. Coronal multiplanar reformation.

 

Figure 39
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  		Fig. 13C —49-year-old man with lung cancer obstructing left mainstem bronchus treated with stent placement. Stent (arrows) has migrated and protrudes into carina. Endoluminal image.

 

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