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Tracheobronchomalacia in the Adult: Is Imaging Helpful?

  • Pulmonary Radiology (M Stephens and S Kapur, Section Editors)
  • Published:
Current Pulmonology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The aim of this article is to: 1) Review the imaging features of tracheobronchomalacia and excessive dynamic airway collapse 2) To highlight the recent advances in imaging of the central airways.

Recent Findings

Imaging of the central airways requires dedicated techniques optimized to evaluate the transient collapse of the central airways either due to excessive movement of the posterior membrane and/or secondary to weakness of the tracheal cartilages. Routine imaging of the chest is limited in its ability to demonstrate the true extent of collapsibility of the airways. The more recently introduced imaging protocols utilize dynamic acquisition during active expiration which demonstrate the transient but true extent of the airway collapse. CT also has potential applications in treatment in the form of 3D-printed splints.

Summary

Dedicated imaging protocols introduced with recent advances in CT technology allow diagnosis of tracheobronchomalacia (TBM) noninvasively. However, there is a current lack of clear threshold for diagnosis which has led to a wide range of reported prevalence of TBM and excessive dynamic airway collapse.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Hammond K, Ghori UK, Musani AI. Tracheobronchomalacia and excessive dynamic airway collapse. Clin Chest Med. 2018;39(1):223–8. This article discusses the distinction between EDAC and TBM which is of paramount importance when making management decisions.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Kheir F, et al. Excessive dynamic airway collapse or tracheobronchomalacia: does it matter? Arch Bronconeumol. 2018.

  4. Boiselle PM, Lee KS, Ernst A. Multidetector CT of the central airways. J Thorac Imaging. 2005;20(3):186–95.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  6. Feist JH, Johnson TH, Wilson RJ. Acquired tracheomalacia: etiology and differential diagnosis. Chest. 1975;68(3):340–5.

    Article  CAS  PubMed  Google Scholar 

  7. Majid A, Guerrero J, Gangadharan S, Feller-Kopman D, Boiselle P, DeCamp M, et al. Tracheobronchoplasty for severe tracheobronchomalacia: a prospective outcome analysis. Chest. 2008;134(4):801–7.

    Article  PubMed  Google Scholar 

  8. Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest. 2005;127(3):984–1005.

    Article  PubMed  Google Scholar 

  9. Snijders D, Barbato A. An update on diagnosis of tracheomalacia in children. Eur J Pediatr Surg. 2015;25(4):333–5.

    Article  PubMed  Google Scholar 

  10. Schmitt P, Dalar L, Jouneau S, Toublanc B, Camuset J, Chatte G, et al. Respiratory conditions associated with rracheobronchomegaly (Mounier-Kuhn syndrome): a study of seventeen cases. Respiration. 2016;91(4):281–7.

    Article  PubMed  Google Scholar 

  11. Azizkhan RG, Lacey SR, Wood RE. Anterior cricoid suspension and tracheal stomal closure for children with cricoid collapse and peristomal tracheomalacia following tracheostomy. J Pediatr Surg. 1993;28(2):169–71.

    Article  CAS  PubMed  Google Scholar 

  12. Abdel Rahim AA, Ahmed ME, Hassan MA. Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre. Br J Surg. 1999;86(1):88–90.

    Article  CAS  PubMed  Google Scholar 

  13. Sebening C, Jakob H, Tochtermann U, Lange R, Vahl CF, Bodegom P, et al. Vascular tracheobronchial compression syndromes-- experience in surgical treatment and literature review. Thorac Cardiovasc Surg. 2000;48(3):164–74.

    Article  CAS  PubMed  Google Scholar 

  14. Ikeda S, et al. Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia. Nihon Kyobu Shikkan Gakkai Zasshi. 1992;30(6):1028–35.

    CAS  PubMed  Google Scholar 

  15. O’Donnell CR, Bankier AA, O’Donnell DH, Loring SH, Boiselle PM. Static end-expiratory and dynamic forced expiratory tracheal collapse in COPD. Clin Radiol. 2014;69(4):357–62.

    Article  PubMed  Google Scholar 

  16. Ernst A, Rafeq S, Boiselle P, Sung A, Reddy C, Michaud G, et al. Relapsing polychondritis and airway involvement. Chest. 2009;135(4):1024–30.

    Article  PubMed  Google Scholar 

  17. McAdam LP, et al. Relapsing polychondritis: prospective study of 23 patients and a review of the literature. Medicine (Baltimore). 1976;55(3):193–215.

    Article  CAS  Google Scholar 

  18. Neilly JB, Winter JH, Stevenson RD. Progressive tracheobronchial polychondritis: need for early diagnosis. Thorax. 1985;40(1):78–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gangadharan SP. Tracheobronchomalacia in adults. Semin Thorac Cardiovasc Surg. 2010;22(2):165–73.

    Article  PubMed  Google Scholar 

  20. Lee EY, Litmanovich D, Boiselle PM. Multidetector CT evaluation of tracheobronchomalacia. Radiol Clin N Am. 2009;47(2):261–9.

    Article  PubMed  Google Scholar 

  21. Nuutinen J. Acquired tracheobronchomalacia. Eur J Respir Dis. 1982;63(5):380–7.

    CAS  PubMed  Google Scholar 

  22. Collard P, Freitag L, Reynaert MS, Rodenstein DO, Francis C. Respiratory failure due to tracheobronchomalacia. Thorax. 1996;51(2):224–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Majid A, Gaurav K, Sanchez JM, Berger RL, Folch E, Fernandez-Bussy S, et al. Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study. Ann Am Thorac Soc. 2014;11(6):951–5.

    Article  PubMed  Google Scholar 

  24. Lee KS, Sun MRM, Ernst A, Feller-Kopman D, Majid A, Boiselle PM. Comparison of dynamic expiratory CT with bronchoscopy for diagnosing airway malacia: a pilot evaluation. Chest. 2007;131(3):758–64.

    Article  PubMed  Google Scholar 

  25. Lee KS, Boiselle PM. Update on multidetector computed tomography imaging of the airways. J Thorac Imaging. 2010;25(2):112–24.

    Article  PubMed  Google Scholar 

  26. Sun M, Ernst A, Boiselle PM. MDCT of the central airways: comparison with bronchoscopy in the evaluation of complications of endotracheal and tracheostomy tubes. J Thorac Imaging. 2007;22(2):136–42.

    Article  PubMed  Google Scholar 

  27. Aquino SL, Shepard JAO, Ginns LC, Moore RH, Halpern E, Grillo HC, et al. Acquired tracheomalacia: detection by expiratory CT scan. J Comput Assist Tomogr. 2001;25(3):394–9.

    Article  CAS  PubMed  Google Scholar 

  28. Honda O, Johkoh T, Yamamoto S, Koyama M, Tomiyama N, Kozuka T, et al. Comparison of quality of multiplanar reconstructions and direct coronal multidetector CT scans of the lung. AJR Am J Roentgenol. 2002;179(4):875–9.

    Article  PubMed  Google Scholar 

  29. Baroni RH, Ashiku S, Boiselle PM. Dynamic CT evaluation of the central airways in patients undergoing tracheoplasty for tracheobronchomalacia. AJR Am J Roentgenol. 2005;184(5):1444–9.

    Article  PubMed  Google Scholar 

  30. Bankier AA, O’Donnell CR, Boiselle PM. Quality initiatives. Respiratory instructions for CT examinations of the lungs: a hands-on guide. Radiographics. 2008;28(4):919–31.

    Article  PubMed  Google Scholar 

  31. Ciet P, Boiselle PM, Heidinger B, Andrinopoulou ER, O’Donnel C, Alsop DC, et al. Cine MRI of tracheal dynamics in healthy volunteers and patients with tracheobronchomalacia. AJR Am J Roentgenol. 2017;209(4):757–61.

    Article  PubMed  Google Scholar 

  32. Slamani MA, Krol A, Beaumont J, Price RL, Coman IL, Lipson ED. Application of phase correlation to the montage synthesis and three-dimensional reconstruction of large tissue volumes from confocal laser scanning microscopy. Microsc Microanal. 2006;12(2):106–12.

    Article  CAS  PubMed  Google Scholar 

  33. Ravenel JG, McAdams HP, Remy-Jardin M, Remy J. Multidimensional imaging of the thorax: practical applications. J Thorac Imaging. 2001;16(4):269–81.

    Article  CAS  PubMed  Google Scholar 

  34. Vining DJ, Liu K, Choplin RH, Haponik EF. Virtual bronchoscopy. Relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest. 1996;109(2):549–53.

    Article  CAS  PubMed  Google Scholar 

  35. Kauczor HU, Wolcke B, Fischer B, Mildenberger P, Lorenz J, Thelen M. Three-dimensional helical CT of the tracheobronchial tree: evaluation of imaging protocols and assessment of suspected stenoses with bronchoscopic correlation. AJR Am J Roentgenol. 1996;167(2):419–24.

    Article  CAS  PubMed  Google Scholar 

  36. McAdams HP, Goodman PC, Kussin P. Virtual bronchoscopy for directing transbronchial needle aspiration of hilar and mediastinal lymph nodes: a pilot study. AJR Am J Roentgenol. 1998;170(5):1361–4.

    Article  CAS  PubMed  Google Scholar 

  37. Remy-Jardin M, Remy J, Artaud D, Fribourg M, Duhamel A. Volume rendering of the tracheobronchial tree: clinical evaluation of bronchographic images. Radiology. 1998;208(3):761–70.

    Article  CAS  PubMed  Google Scholar 

  38. Salvolini L, Bichi Secchi E, Costarelli L, de Nicola M. Clinical applications of 2D and 3D CT imaging of the airways--a review. Eur J Radiol. 2000;34(1):9–25.

    Article  CAS  PubMed  Google Scholar 

  39. Boiselle PM, Reynolds KF, Ernst A. Multiplanar and three-dimensional imaging of the central airways with multidetector CT. AJR Am J Roentgenol. 2002;179(2):301–8.

    Article  PubMed  Google Scholar 

  40. Hein E, Rogalla P, Hentschel C, Taupitz M, Hamm B. Dynamic and quantitative assessment of tracheomalacia by electron beam tomography: correlation with clinical symptoms and bronchoscopy. J Comput Assist Tomogr. 2000;24(2):247–52.

    Article  CAS  PubMed  Google Scholar 

  41. 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 

  42. Buitrago D, et al. Current concepts in severe adult tracheobronchomalacia: evaluation and treatment. J Thorac Dis. 2017;9:E57–66.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zhang J, et al. AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques. Acad Radiol. 2003;10(7):719–24.

    Article  PubMed  Google Scholar 

  44. Zopf DA, Hollister SJ, Nelson ME, Ohye RG, Green GE. Bioresorbable airway splint created with a three-dimensional printer. N Engl J Med. 2013;368(21):2043–5.

    Article  CAS  PubMed  Google Scholar 

  45. Stehlik L, et al. Biodegradable polydioxanone stents in the treatment of adult patients with tracheal narrowing. BMC Pulm Med. 2015;15:164.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. • Bezuidenhout AF, et al. Longitudinal follow-up of patients with tracheobronchomalacia after undergoing tracheobronchoplasty: computed tomography findings and clinical correlation. J Thorac Imaging. 2018. This article describes the intermediate and long-term changes in expiratory tracheal collapsibility by computed tomography (CT) in patients with tracheobronchomalacia following surgical treatment with tracheobronchoplasty and correlates the CT findings with clinical findings.

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Correspondence to Aamer R. Chughtai.

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Aamer R Chughtai and Prachi P Agarwal declare no conflict of interest.

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Chughtai, A.R., Agarwal, P.P. Tracheobronchomalacia in the Adult: Is Imaging Helpful?. Curr Pulmonol Rep 8, 78–85 (2019). https://doi.org/10.1007/s13665-019-00228-9

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