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Imaging of Large and Small Airways

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Thoracic Imaging

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Abstract

Large airways or the central airways are composed of trachea and bronchi. The human tracheobronchial tree has 23 generations with the lobar bronchi being the first generation. The proximal, approximately, 16 generations of bronchi have conductive function, while the distal airways take part in gas exchange with a transition zone between the two where the bronchioles have both functions (Fig. 2.1). The respiratory bronchiole, alveolar duct, and alveolar sac have pure gas exchange function. The measurements of the trachea are described in Table 2.1 [1, 2]. The tracheal wall is composed of multiple rigid C-shaped hyaline cartilages covering the anterolateral wall and a collapsible membrane in posterior wall composed of muscle (trachealis) and connective tissue. CT plays an essential role in the identification of lobar and segmental bronchi as well as fissures. This is important in preoperative localization of the endobronchial and parenchymal lesion. The right bronchus is wider, shorter, and more vertical than the left lung. This leads to higher chances of right endobronchial intubation. The right bronchus, after giving rise to upper lobe bronchus, continues as bronchus intermedius and bifurcates into longer right middle lobe bronchus and shorter right lower lobe bronchus. The left bronchus divides into an upper lobe and lower lobe bronchus and subsequently to their segmental bronchi. Lingular bronchus arises from the left upper lobe bronchus. The segmental bronchi help in localizing the bronchopulmonary segments (Table 2.2).

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References

  1. Gamsu G, Webb WR. Computed tomography of the trachea: normal and abnormal. Am J Roentgenol. 1982;139(2):321–6.

    Article  CAS  Google Scholar 

  2. Boiselle PM. Imaging of the large airways. Clin Chest Med. 2008;29(1):181–93.

    Article  PubMed  Google Scholar 

  3. Glazer HS, Anderson DJ, DiCroce JJ, Solomon SL, Wilson BS, Molina PL, Sagel SS. Anatomy of the major fissure: evaluation with standard and thin-section CT. Radiology. 1991;180(3):839–44.

    Article  CAS  PubMed  Google Scholar 

  4. Aziz A, Ashizawa K, Nagaoki K, Hayashi K. High resolution CT anatomy of the pulmonary fissures. J Thorac Imaging. 2004;19(3):186–91.

    Article  PubMed  Google Scholar 

  5. Arıyürek MO, Gülsün M, Demirkazık F. Accessory fissures of the lung: evaluation by high-resolution computed tomography. Eur Radiol. 2001;11(12):2449–53.

    Article  PubMed  Google Scholar 

  6. Buterbaugh JE, Erly WK. Paratracheal air cysts: a common finding on routine CT examinations of the cervical spine and neck that may mimic pneumomediastinum in patients with traumatic injuries. Am J Neuroradiol. 2008;29(6):1218–21.

    Article  CAS  PubMed  Google Scholar 

  7. Gipson MG, Cummings KW, Hurth KM. Bronchial atresia. Radiographics. 2009;29(5):1531–5.

    Article  PubMed  Google Scholar 

  8. Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ. Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics. 2009;29(1):55–71.

    Article  PubMed  Google Scholar 

  9. Ngo AV, Walker CM, Chung JH, Takasugi JE, Stern EJ, Kanne JP, Reddy GP, Godwin JD. Tumors and tumorlike conditions of the large airways. Am J Roentgenol. 2013;201(2):301–13.

    Article  Google Scholar 

  10. Morshed K, Trojanowska A, Szymański M, Trojanowski P, Szymańska A, Smoleń A, Drop A. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol. 2011;268(4):591–7.

    Article  PubMed  Google Scholar 

  11. Zaghi S, Alonso J, Orestes M, Kadin N, Hsu W, Berke G. Idiopathic subglottic stenosis: a comparison of tracheal size. Ann Otol Rhinol Laryngol. 2016;125(8):622–6.

    Article  PubMed  Google Scholar 

  12. Bhalla M, Grillo HC, McLoud TC, Shepard JO, Weber AL, Mark EJ. Idiopathic laryngotracheal stenosis: radiologic findings. AJR Am J Roentgenol. 1993;161(3):515–7.

    Article  CAS  PubMed  Google Scholar 

  13. Kim Y, Lee KS, Yoon JH, Chung MP, Kim H, Kwon OJ, Rhee CH, Han YC. Tuberculosis of the trachea and main bronchi: CT findings in 17 patients. AJR Am J Roentgenol. 1997;168(4):1051–6.

    Article  CAS  PubMed  Google Scholar 

  14. Seo JB, Song KS, Lee JS, Goo JM, Kim HY, Song JW, Lee IS, Lim TH. Broncholithiasis: review of the causes with radiologic-pathologic correlation. Radiographics. 2002;22(suppl_1):S199–213.

    Article  PubMed  Google Scholar 

  15. Park HJ, Park SH, Im SA, Kim YK, Lee KY. CT differentiation of anthracofibrosis from endobronchial tuberculosis. Am J Roentgenol. 2008;191(1):247–51.

    Article  Google Scholar 

  16. Greene R, Lechner GL. “Saber-sheath” trachea: a clinical and functional study of marked coronal narrowing of the intrathoracic trachea. Radiology. 1975;115(2):265–8.

    Article  CAS  PubMed  Google Scholar 

  17. Gilkeson RC, Ciancibello LM, Hejal RB, Montenegro HD, Lange P. Tracheobronchomalacia: dynamic airway evaluation with multidetector CT. Am J Roentgenol. 2001;176(1):205–10.

    Article  CAS  Google Scholar 

  18. Baroni RH, Feller-Kopman D, Nishino M, Hatabu H, Loring SH, Ernst A, Boiselle PM. Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse. Radiology. 2005;235(2):635–41.

    Article  PubMed  Google Scholar 

  19. Stern EJ, Graham CM, Webb WR, Gamsu G. Normal trachea during forced expiration: dynamic CT measurements. Radiology. 1993;187(1):27–31.

    Article  CAS  PubMed  Google Scholar 

  20. Kang EY. Large airway diseases. J Thorac Imaging. 2011;26(4):249–62.

    Article  PubMed  Google Scholar 

  21. Heidinger BH, Occhipinti M, Eisenberg RL, Bankier AA. Imaging of large airways disorders. Am J Roentgenol. 2015;205(1):41–56.

    Article  Google Scholar 

  22. Hill LE, Ritchie G, Wightman AJ, Hill AT, Murchison JT. Comparison between conventional interrupted high-resolution CT and volume multidetector CT acquisition in the assessment of bronchiectasis. Br J Radiol. 2010;83(985):67–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Dodd JD, Souza CA, Müller NL. Conventional high-resolution CT versus helical high-resolution MDCT in the detection of bronchiectasis. Am J Roentgenol. 2006;187(2):414–20.

    Article  Google Scholar 

  24. Kim JS, Müller NL, Park CS, Grenier P, Herold CJ. Cylindrical bronchiectasis: diagnostic findings on thin-section CT. AJR Am J Roentgenol. 1997;168(3):751–4.

    Article  CAS  PubMed  Google Scholar 

  25. Perera PL, Screaton NJ. 5 Radiological features of bronchiectasis. Eur Respir Monogr. 2011;1(52):44.

    Google Scholar 

  26. Komiya K, Ishii H, Umeki K, Kawamura T, Okada F, Okabe E, Murakami J, Kato Y, Matsumoto B, Teramoto S, Johkoh T. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int. 2013;13(3):580–5.

    Article  PubMed  Google Scholar 

  27. Shah A, Panjabi C. Allergic aspergillosis of the respiratory tract. Eur Respir Rev. 2014;23(131):8–29.

    Article  PubMed  Google Scholar 

  28. Tanaka N, Kim JS, Bates CA, Brown KK, Cool CD, Newell JD, Lynch DA. Lung diseases in patients with common variable immunodeficiency: chest radiographic, and computed tomographic findings. J Comput Assist Tomogr. 2006;30(5):828–38.

    Article  PubMed  Google Scholar 

  29. Mishra M, Kumar N, Jaiswal A, Verma AK, Kant S. Kartagener’s syndrome: a case series. Lung India. 2012;29(4):366.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med. 1998;157(5):1658–65.

    Article  CAS  PubMed  Google Scholar 

  31. D’Andrea N, Vigliarolo R, Sanguinetti CM. Respiratory involvement in inflammatory bowel diseases. Multidiscip Respir Med. 2010;5(3):173.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Helbich TH, Heinz-Peer G, Fleischmann D, Wojnarowski C, Wunderbaldinger P, Huber S, Eichler I, Herold CJ. Evolution of CT findings in patients with cystic fibrosis. AJR Am J Roentgenol. 1999;173(1):81–8.

    Article  CAS  PubMed  Google Scholar 

  33. King MA, Stone JA, Diaz PT, Mueller CF, Becker WJ, Gadek JE. Alpha 1-antitrypsin deficiency: evaluation of bronchiectasis with CT. Radiology. 1996;199(1):137–41.

    Article  CAS  PubMed  Google Scholar 

  34. Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image—the 2004 Fleischner lecture. Radiology. 2006;239(2):322–38.

    Article  PubMed  Google Scholar 

  35. Desai SR, Hansell DM. Small airways disease: expiratory computed tomography comes of age. Clin Radiol. 1997;52(5):332–7.

    Article  CAS  PubMed  Google Scholar 

  36. Abbott GF, Rosado-de-Christenson ML, Rossi SE, Suster S. Imaging of small airways disease. J Thorac Imaging. 2009;24(4):285–98.

    Article  PubMed  Google Scholar 

  37. Hansell DM. Small airways diseases: detection and insights with computed tomography. Eur Respir J. 2001;17(6):1294–313.

    Article  CAS  PubMed  Google Scholar 

  38. Berniker AV, Henry TS. Imaging of small airways diseases. Radiol Clin North Am. 2016;54(6):1165–81.

    Article  PubMed  Google Scholar 

  39. Moore AD, Godwin JD, Dietrich PA, Verschakelen JA, Henderson WR Jr. Swyer-James syndrome: CT findings in eight patients. AJR Am J Roentgenol. 1992;158(6):1211–5.

    Article  CAS  PubMed  Google Scholar 

  40. Marti-Bonmati L, Ruiz Perales F, Catala F, Mata JM, Calonge E. CT findings in Swyer-James syndrome. Radiology. 1989;172(2):477–80.

    Article  CAS  PubMed  Google Scholar 

  41. Davies SJ, Gosney JR, Hansell DM, Wells AU, du Bois RM, Burke MM, Sheppard MN, Nicholson AG. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: an under-recognised spectrum of disease. Thorax. 2007;62(3):248–52.

    Article  PubMed  Google Scholar 

  42. Rossi G, Cavazza A, Spagnolo P, Sverzellati N, Longo L, Jukna A, Montanari G, Carbonelli C, Vincenzi G, Bogina G, Franco R. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia syndrome. Eur Respir J. 2016;47(6):1829–41.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore

    Ashish Chawla

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  1. Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore

    Ashish Chawla

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Chawla, A. (2019). Imaging of Large and Small Airways. In: Chawla, A. (eds) Thoracic Imaging. Springer, Singapore. https://doi.org/10.1007/978-981-13-2544-1_2

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  • DOI: https://doi.org/10.1007/978-981-13-2544-1_2

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  • Print ISBN: 978-981-13-2543-4

  • Online ISBN: 978-981-13-2544-1

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