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MDCT Detection of Airway Stent Complications: Comparison with Bronchoscopy

¹ Center for Airway Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
² Department of Interventional Pulmonary Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Intraluminal narrowing due to granulation tissue in metallic stent placed after lung transplantation for anastomotic stenosis in 16-year-old girl. Oblique reformation CT image (bone window) along axis of left main bronchus shows that polypoid soft-tissue density (arrows), which was proven to be granulation tissue response at bronchoscopy, is narrowing airway lumen.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Migrated metallic stent in 61-year-old woman with non–small cell lung carcinoma. Coronal oblique CT image (bone window) shows that proximal aspect of stent (arrow) above carina is extending into adjacent paratracheal soft tissues. Stent has migrated from initial location in proximal right bronchus and is responsible for causing partial collapse of right upper lobe.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Silicone stent migration and tumor invasion in 41-year-old woman with metastatic non–small cell lung carcinoma. Coronal reformation CT image shows that proximal aspect of stent (arrow) is at carina due to stent migration.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Silicone stent migration and tumor invasion in 41-year-old woman with metastatic non–small cell lung carcinoma. Axial CT image shows intraluminal soft-tissue density (arrow) at site of disrupted stent that was proven to represent tumor invasion at bronchoscopy. Note collapse of left lung.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Airway perforation due to stent erosion in 76-year-old man with history of non–small cell lung cancer and radiation therapy. Axial CT image (lung window) shows extraluminal gas collection (arrow) contiguous with proximal right main bronchus that was due to contained perforation secondary to metallic stent erosion of lateral bronchial wall.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Metallic stent fracture in 78-year-old man with non–small cell lung cancer who presented for follow-up after radiation therapy. Coronal reformation CT image (bone window) shows focal disruption (arrow) of proximal aspect of stent with lateral protrusion of fragment. Also note intraluminal granulation tissue. Stent was focally fractured at bronchoscopy.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Metallic stent fracture in 78-year-old man with non–small cell lung cancer who presented for follow-up after radiation therapy. After removal of metallic stent, coronal CT image was used to provide measurements for custom-designed silicone stent for lower trachea and proximal bronchi.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Metallic stent fracture in 78-year-old man with non–small cell lung cancer who presented for follow-up after radiation therapy. Photograph shows custom-designed stent. (Reprinted with permission from Lee KS, Lunn W, Feller-Kopman D, Ernst A, Hatabu H, Boiselle PM. Multislice CT evaluation of airway stents. J Thorac Imaging 2005; 20:81–88 [8])

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Normal metallic stent in 45-year-old woman with history of tracheomalacia. Coronal oblique CT image (bone window) shows intact metallic stent (arrow).

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Normal metallic stent in 45-year-old woman with history of tracheomalacia. Photograph shows metallic stent before deployment. (Reprinted with permission from Lee KS, Lunn W, Feller-Kopman D, Ernst A, Hatabu H, Boiselle PM. Multislice CT evaluation of airway stents. J Thorac Imaging 2005; 20:81–88 [8])

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Normal appearance of silicone stent. Virtual bronchoscopic image shows intraluminal perspective of stent. Note external stud (arrow) that is stabilization device to help prevent dislodgement.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Normal appearance of silicone stent. Photograph of silicone stent shows numerous external studs.

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