Tracheobronchomalacia: Evolving role of dynamic multislice helical CT
Section snippets
Diagnostic methods
Tracheobronchomalacia often escapes detection clinically because the symptoms (cough, wheeze, stridor, and dyspnea) are nonspecific and overlap with other pulmonary disorders, such as emphysema and asthma. Moreover, TBM usually eludes detection radiographically because traditional imaging studies performed at end-inspiration do not allow for an assessment of airway collapsibility. Historically, cine fluoroscopy has been used to diagnose this condition (Fig. 1) [8]. This method is limited,
Dynamic multislice helical CT
To evaluate for TBM, it is necessary to image the patient during inspiration and expiration. Because the maximal degree of collapse in TBM usually occurs during exhalation rather than at end-expiration [2], dynamic expiratory imaging is preferable to end-expiratory imaging. Fig. 7 illustrates an example of underestimation of the degree of airway collapse when end-expiratory images are used for assessing for malacia.
Volumetric imaging ensures that the entirety of the central airways is imaged,
Tracheoplasty
A variety of surgical methods have been applied to the treatment of tracheomalacia [17], [18]. Tracheoplasty, which refers to reshaping and reinforcing of the posterior membranous wall of the airway with a graft, seems to be the most promising surgical method at present [17]. In this procedure, the posterior membranous wall of the trachea is exposed from side-to-side and from high in the thoracic inlet to the bilateral lobar bronchi takeoffs distally. Marlex mesh is fashioned into an
Summary
Paired inspiratory and dynamic expiratory multislice CT imaging is a promising method for diagnosing TBM. A low-dose technique should be considered for the dynamic portion to reduce radiation exposure. Visual and quantitative analysis of the central airways provide a comprehensive assessment by allowing for the accurate diagnosis of TBM, determining its extent, assessing for predisposing conditions, and aiding selection of candidates for stent placement or tracheoplasty procedures. This
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Cited by (94)
Interventionnal bronchoscopy for the treatment of tracheobronchomalacia
2023, Revue des Maladies RespiratoiresTracheobronchoplasty yields long-term anatomy, function, and quality of life improvement for patients with severe excessive central airway collapse
2023, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :The BI demonstrated a steep decrease in the median percent of expiratory airway collapse at years 1 (40.0% [IQR, 28.6-63.3], P < .001) and 2 (53.6% [IQR, 35.4-65.2], P = .001). Although the improvement from baseline was not statistically significant at year 5, the degree of collapse in the BI still remained within the range seen in healthy volunteers.11 Similar effect was observed in the left mainstem bronchus (LMSB) with a reduction in the median percent expiratory airway collapse at years 1 (50.0% [IQR, 35.4-66.6], P < .001), 2 (48.1% [IQR, 36.9-56.3], P < .001), and 5 (50.0% [IQR, 41.6-60.0], P = .115) compared with baseline.
Tracheobronchomalacia
2017, Disease-a-MonthDiagnostic Imaging: Pediatrics
2017, Diagnostic Imaging: Pediatrics