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Tracheobronchomalacia: Comparison between End-expiratory and Dynamic Expiratory CT for Evaluation of Central Airway Collapse¹

¹ From the Departments of Radiology (R.H.B., M.N., H.H., P.M.B.), Pulmonary Medicine (D.F.K., A.E.), and Anesthesia (S.H.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215. Received February 19, 2004; revision requested April 29; revision received June 22; accepted July 27. Address correspondence to P.M.B. (e-mail: pboisell@caregroup.harvard.edu).

View larger version (114K): [in a new window]   Figure 1. Patient 5. Transverse CT scan obtained at end inspiration with the cross-sectional area measurement of the trachea at the level of the aortic arch. The tracing line has been electronically thickened to enhance visibility for photographic reproduction.

View larger version (132K): [in a new window]   Figure 2a. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (124K): [in a new window]   Figure 2b. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (113K): [in a new window]   Figure 2c. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (120K): [in a new window]   Figure 2d. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (118K): [in a new window]   Figure 2e. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (101K): [in a new window]   Figure 2f. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (133K): [in a new window]   Figure 2g. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (133K): [in a new window]   Figure 2h. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).

View larger version (147K): [in a new window]   Figure 2i. CT scans show comparison of airway collapse during expiratory maneuvers at three transverse anatomic levels; selected airway level is marked by arrow. (a-c) Patient 7. Scans show (a) normal tracheal appearance of the aortic arch at end inspiration, (b) slight decrease in caliber at end expiration, and (c) substantial collapse (>50%) during dynamic expiration. (d-f) Patient 13. Scans show (d) normal caliber of the carina at end inspiration, (e) a small degree of collapse at end expiration, and (f) substantial (>50%) collapse during dynamic expiration. (g-i) Patient 12. Scans show (g) normal caliber of the bronchus intermedius at end inspiration, (h) slight collapse at end expiration, and (i) substantial (>50%) collapse during dynamic expiration; also note substantial collapse of the left main bronchus (arrowhead).