CT of the Airways pp 121-149 | Cite as
Tracheobronchial Stenoses
Summary
Tracheobronchial stenosis is defined as focal or diffuse narrowing of the tracheal lumen. It may arise secondary to a wide variety of benign and malignant causes (Table 1). This chapter describes a general approach to the recognition and characterization of tracheobronchial stenoses and reviews specific clinical and imaging features of various benign causes for this condition. Neoplastic etiologies are reviewed separately in the chapter devoted to tracheobronchial neoplasms. Special emphasis is placed upon post-intubation stenosis, which is by far the most common etiology encountered in daily practice. Other, less common etiologies are subsequently discussed in alphabetical order following this entity.
Key Words
Trachea bronchi stenosis benign CTPreview
Unable to display preview. Download preview PDF.
References
- 1.Boiselle PM, Ernst A. Recent advances in central airway imaging. Chest 2002;121:1651–1660.PubMedCrossRefGoogle Scholar
- 2.Boiselle PM, Reynolds KF, Ernst A. Multiplanar and three-dimensional imaging of the central airways with multidetector CT. AJR Am J Roentgenol 2002;179:301–308.PubMedGoogle Scholar
- 3.Salvolini L, Secchi EB, Costarelli L, De Nicola M. Clinical applications of 2D and 3D CT imaging of the airways—a review. Eur J Radiol 2000;34:9–25.PubMedCrossRefGoogle Scholar
- 4.Naidich DP, Gruden JF, McGuiness GM, McCauley DI, Bhalla M. Volumetric (helical/spiral) CT (VCT) of the airways. J Thorac Imaging 1997;12:11–28.PubMedCrossRefGoogle Scholar
- 5.Remy-Jardin M, Remy J, Artaud D, Fribourg M, Naili A. Tracheobronchial tree: assessment with volume rendering-technical aspects. Radiology 1998;208:393–398.PubMedGoogle Scholar
- 6.Remy-Jardin M, Remy J, Artaud D, Fribourg M, Duhamel A. Volume rendering of the tracheobronchial tree: clinical evaluation of bronchographic images. Radiology 1998;208:761–770.PubMedGoogle Scholar
- 7.Remy-Jardin M, Remy J, Deschildre F, Artaud D, Ramon P, Edme JL. Obstructive lesions of the central airways: evaluation by using spiral CT with multiplanar and three-dimensional reformations. Eur Radiol 1996;6:807–816.PubMedCrossRefGoogle Scholar
- 8.Rubin GD. Data explosion: the challenge of multidetector-row CT. Eur J Radiol 2000;36:74–80.PubMedCrossRefGoogle Scholar
- 9.Lee KS, Ernst A, Trentham D, Lunn W, Feller-Kopman D, Boiselle, PM. Prevalence of functional airway abnormalities in relapsing polychondritis. Radiology 2006;240:565–573.PubMedCrossRefGoogle Scholar
- 10.Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP. Relapsing polychondritis affecting the lower respiratory tract. AJR Am J Roentgenol 2002;178:173–177.PubMedGoogle Scholar
- 11.Fraser RS, Colman N, Müller NL, Pare PD. Upper airway obstruction. In: Fraser and Pare’s Diagnosis of Diseases of the Chest, 4th Ed. Fraser RS, Colman N, Müller NL, Pare PD, Eds. W.B. Saunders Co, Philadelphia, 1999, pp. 2033–2036.Google Scholar
- 12.Prince JS, Duhamel DR, Levin DL, et al. Nonneoplastic lesions of the tracheobronchial wall: radiographic findings with bronchoscopic correlation. Radiographics 2002;22:S215–S230.PubMedGoogle Scholar
- 13.Stauffer J, Olson D, Petty T. Complications and consequences of endotracheal intubation and tracheostomy. A prospective study of 150 critically ill adult patients. Am J Med 1981;70:65–76.PubMedCrossRefGoogle Scholar
- 14.Norwood S, Vallina V, Short K, et al. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg 2000;232:233–241.PubMedCrossRefGoogle Scholar
- 15.Webb EM, Elicker BM, Webb WR. Using CT to diagnose nonneoplastic tracheal abnormalities. AJR Am J Roentgenol 2000;174:1315–1321.PubMedGoogle Scholar
- 16.Ernst A, Herth F, Becker H. Overview of the management of central airway obstruction. In: UpToDate, Rose, BD, Ed. UpToDate, Waltham, MA, 2006.Google Scholar
- 17.Marom EM, Goodman PC, McAdams HP. Focal abnormalities of the trachea and bronchi. AJR Am J Roentgenol 2001;176:707–711.PubMedGoogle Scholar
- 18.Toyoda M, Ebihara Y, Kato H, Kita S. Tracheobronchial AL amyloidosis: histologic, immunohistochemical, ultrastructural, and immunoelectron microscopic observations. Hum Pathol 1993;24:970–976.PubMedCrossRefGoogle Scholar
- 19.Thompson PJ, Citron KM. Amyloid and the lower respiratory tract. Thorax 1983;38:84–87.PubMedGoogle Scholar
- 20.Gottlieb LS, Gold WM. Primary tracheobronchial amyloidosis. Am Rev Respir Dis 1972;105:425–429.PubMedGoogle Scholar
- 21.Rubinow A, Celli BR, Cohen AS, Rigden BG, Brody JS. Localized amyloidosis of the lower respiratory tract. Am Rev Respir Dis 1978;118:603–611.PubMedGoogle Scholar
- 22.Prowse C. Amyloidosis of the lower respiratory tract. Thorax 1958;13:308–320.PubMedGoogle Scholar
- 23.Gross BH, Felson B, Birnberg FA. The respiratory tract in amyloidosis and the plasma cell dyscrasias. Semin Roentgenol 1986;21:113–127.PubMedCrossRefGoogle Scholar
- 24.Naef AP, Savary M, Gruneck JM, Baumann RP. Amyloid pseudotumor treated by tracheal resection. Ann Thorac Surg 1977;23:578–581.PubMedCrossRefGoogle Scholar
- 25.Breuer R, Simpson GT, Rubinow A, Skinner M, Cohen AS. Tracheobronchial amyloidosis: treatment by carbon dioxide laser photoresection. Thorax 1985;40:87.Google Scholar
- 26.Hui AN, Koss MN, Hochholzer L, Wehunt WD. Amyloidosis presenting in the lower respiratory tract. Clinicopathologic, radiologic, immunohistochemical, and histochemical studies on 48 cases. Arch Pathol Lab Med 1986;110:212–218.PubMedGoogle Scholar
- 27.Piazza C, Cavaliere S, Foccoli P, Toninelli C, Bolzoni A, Peretti G. Endoscopic management of laryngo-tracheobronchial amyloidosis: a series of 32 patients. Eur Arch Otorhinolaryngol 2003;260:349–354.PubMedCrossRefGoogle Scholar
- 28.Ozer C, Nass Duce M, Yildiz A, Apaydin FD, Egilmez H, Arpaci T. Primary diffuse tracheobronchial amyloidosis: case report. Eur J Radiol 2002;44:37–39.PubMedCrossRefGoogle Scholar
- 29.O’Regan A, Fenlon HM, Beamis JF Jr, Steele MP, Skinner M, Berk JL. Tracheobronchial amyloidosis. The Boston University experience from 1984 to 1999. Medicine (Baltimore) 2000;79:69–79.CrossRefGoogle Scholar
- 30.Cotton R, Jackson J. Localized amyloid ‘tumours’ of the lung simulating malignant neoplasms. Thorax 1964;19:97–103.PubMedCrossRefGoogle Scholar
- 31.Weissman B, Wong M, Smith DN. Image interpretation session: 1996. Radiographics 1997;17:244–245.Google Scholar
- 32.Dalton H, Featherstone T, Athanasou N. Organ limited amyloidosis with lymphadenopathy. Postgrad Med J 1992;68: 47–50.PubMedGoogle Scholar
- 33.Schmidt H, McDonald J, Clagett O. Amyloid tumours of the lower respiratory tract and mediastinum. Ann Otol Rhinol Laryngol 1953;62:880–893.PubMedGoogle Scholar
- 34.Crestani B, Monnier A, Kambouchner M, Battesti JP, Reynaud P, Valeyre D. Tracheobronchial amyloidosis with hilar lymphadenopathy associated with a serum monoclonal immunoglobulin. Eur Respir J 1993;6:1569–1571.PubMedGoogle Scholar
- 35.Flemming AF, Fairfax AJ, Arnold AG, Lane DJ. Treatment of endobronchial amyloidosis by intermittent bronchoscopic resection. Br J Dis Chest 1980;74:183–188.PubMedCrossRefGoogle Scholar
- 36.Yang S, Chia SY, Chuah KL, Eng P. Tracheobronchial amyloidosis treated with rigid bronchoscopy and stenting. Surg Endosc 2003;17:658–659.PubMedCrossRefGoogle Scholar
- 37.Kalra S, Utz JP, Edell ES, Foote RL. External-beam radiation therapy in the treatment of diffuse tracheobronchial amyloidosis. Mayo Clin Proc 2001;76:853–856.PubMedGoogle Scholar
- 38.Ashiku SK, Mathieson D. Idiopathic laryngotracheal stenosis. Chest Surg Clin N Am 2003;13(2):257–269.PubMedCrossRefGoogle Scholar
- 39.Ashiku SK, Kuzucu A, Grillo HC, et al. Idiopathic laryngotracheal stenosis: effective definitive treatment with laryngotracheal resection. J Thorac Cardiovasc Surg 2004;127(1):99–107.PubMedCrossRefGoogle Scholar
- 40.Camus P, Colby TV. The lung in inflammatory bowel disease. Eur Respir J 2000;15:5–10.PubMedCrossRefGoogle Scholar
- 41.Herrington HC, Weber SM, Andersen PE. Modern management of laryngotracheal stenosis. Laryngoscope 2006;116(9):1553–1557.PubMedCrossRefGoogle Scholar
- 42.Plataki M, Tzortzaki E, Lambiri I, et al. Severe airway stenosis associated with Crohn’s disease: case report. BMC Pulm Med 2006;6:7.PubMedCrossRefGoogle Scholar
- 43.Ulrich R, Goldberg R, Line WS. Crohn’s disease: a rare cause of upper airway obstruction. J Emerg Med 2000;19: 331–332.PubMedCrossRefGoogle Scholar
- 44.Trentham DE, Le CH. Relapsing polychondritis. Ann Intern Med 1998;129:114–122.PubMedGoogle Scholar
- 45.Herman JH. Relapsing polychondritis. In: UpToDate, Rose, BD, Ed. UpToDate, Waltham, MA, 2006.Google Scholar
- 46.Letko E, Zafirakis P, Baltatzis S, et al. Relapsing polychondritis: a clinical review. Semin Arthritis Rheum 2002;31:384–395.PubMedCrossRefGoogle Scholar
- 47.Tsunezuka Y, Sato H, Shimizu H. Tracheobronchial involvement in relapsing polychondritis. Respiration 2000;67:320–322.PubMedCrossRefGoogle Scholar
- 48.Heman-Ackhah YD, Remley KB, Goding GS Jr. A new role for magnetic resonance imaging in the diagnosis of laryngeal relapsing polychondritis. Head Neck 1999;21:484–489.CrossRefGoogle Scholar
- 49.Gergely P Jr, Poor G. Relapsing polychondritis. Best Pract Res Clin Rheumatol 2004;18:723–738.PubMedCrossRefGoogle Scholar
- 50.Soni NK. Scleroma of the lower respiratory tract: a bronchoscopic study. J Laryngol Otol 1994;108:484–485.PubMedGoogle Scholar
- 51.Brandstetter RD, Messina MS, Sprince NL, Grillo HC. Tracheal stenosis due to sarcoidosis. Chest 1981;80:656.PubMedCrossRefGoogle Scholar
- 52.Lefrak S, Di Benedetto R. Systematic sarcoidosis with severe involvement of the upper respiratory tract. Am Rev Respir Dis 1970;102:801–807.PubMedGoogle Scholar
- 53.Henry DA, Cho SR. Tracheal stenosis in sarcoidosis. South Med J 1983;76:1323–1324.PubMedGoogle Scholar
- 54.Kirschner BS, Holinger PH. Laryngeal obstruction in children sarcoidosis. J Pediatr 1976;88:263–265.PubMedCrossRefGoogle Scholar
- 55.Weisman RA, Canalis RF, Powell WJ. Laryngeal sarcoidosis with airway obstruction. Ann Otol Rhinol Laryngol 1980;89:58–61.PubMedGoogle Scholar
- 56.Miller A, Brown LK, Teirstein AS. Stenosis of main bronchi mimicking fixed upper airway obstruction in sarcoidosis. Chest 1985;88:244–248.PubMedCrossRefGoogle Scholar
- 57.Rockoff SD, Rohatgi PK. Unusual manifestations of thoracic sarcoidosis. AJR Am J Roentgenol 1985;144:513–528.PubMedGoogle Scholar
- 58.Scadding JG, Mitchell DN. Sarcoidosis. London: Chapman and Hall; 1985.Google Scholar
- 59.Olsson T, Bjornstad-Pettersen H, Stjernberg NL. Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease. Chest 1979;75:663–666.PubMedCrossRefGoogle Scholar
- 60.Hadfield JW, Page RL, Flower CD, Stark JE. Localised airway narrowing in sarcoidosis. Thorax 1982;37:443–447.PubMedGoogle Scholar
- 61.Udwadia ZF, Pilling JR, Jenkins PF, Harrison BD. Bronchoscopic and bronchographic findings in 12 patients with sarcoidosis and severe or progressive airways obstruction. Thorax 1990;45:272–275.PubMedGoogle Scholar
- 62.Conant EF, Glickstein MF, Mahar P, Miller WT. Pulmonary sarcoidosis in the older patient: conventional radiographic features. Radiology 1988;169:315–319.PubMedGoogle Scholar
- 63.Dorman RL Jr, Whitman GJ, Chew FS. Thoracic sarcoidosis. AJR Am J Roentgenol 1995;164:1368.PubMedGoogle Scholar
- 64.Corsello BF, Lohaus GH, Funahashi A. Endobronchial mass lesion due to sarcoidosis: complete resolution with corticosteroids. Thorax 1983;38:157–158.PubMedGoogle Scholar
- 65.Smellie H, Hoyle C. The natural history of pulmonary sarcoidosis. Q J Med 1960;29:539–559.Google Scholar
- 66.Kirks DR, McCormick VD, Greenspan RH. Pulmonary sarcoidosis. Roentgenologic analysis of 150 patients. Am J Roentgenol Radium Ther Nucl Med 1973;117:777–786.PubMedGoogle Scholar
- 67.Freundlich IM, Libshitz HI, Glassman LM, Israel HL. Sarcoidosis. Typical and atypical thoracic manifestations and complications. Clin Radiol 1970;21:376–383.PubMedCrossRefGoogle Scholar
- 68.Romer FK. Presentation of sarcoidosis and outcome of pulmonary changes. Dan Med Bull 1982;29:27–32.PubMedGoogle Scholar
- 69.Ellis K, Renthal G. Pulmonary sarcoidosis. Roentgenographic observations on course of disease. AJR Am J Roentgenol 1962;88:1070–1083.Google Scholar
- 70.Rabinowitz JG, Ulreich S, Soriano C. The usual unusual manifestations of sarcoidosis and the “hilar haze”—a new diagnostic aid. Am J Roentgenol Radium Ther Nucl Med 1974;120:821–831.PubMedGoogle Scholar
- 71.Lenique F, Brauner MW, Grenier P, Battesti JP, Loiseau A, Valeyre D. CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations. Radiology 1995;194:419–423.PubMedGoogle Scholar
- 72.Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis. Chest 2001;120:881–886.PubMedCrossRefGoogle Scholar
- 73.Munt PW. Middle lobe atelectasis in sarcoidosis. Report of a case with prompt resolution concomitant with corticosteroid administration. Am Rev Respir Dis 1973;108:357–360.PubMedGoogle Scholar
- 74.Fouty BW, Pomeranz M, Thigpen TP, Martin RJ. Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope. Chest 1994;106:677–680.PubMedCrossRefGoogle Scholar
- 75.Iles PB. Multiple bronchial stenoses: treatment by mechanical dilatation. Thorax 1981;36:784–786.PubMedGoogle Scholar
- 76.Mayse ML, Greenheck J, Friedman M, Kovitz KL. Successful bronchoscopic balloon dilation of nonmalignant tracheobronchial obstruction without fluoroscopy. Chest 2004;126:634–637.PubMedCrossRefGoogle Scholar
- 77.Curtin JJ, Innes NJ, Harrison BD. Thin-section spiral volumetric CT for the assessment of lobar and segmental bronchial stenoses. Clin Radiol 1998;53:110–115.PubMedCrossRefGoogle Scholar
- 78.Restrepo S, Pandit M, Villamil MA, Rojas IC, Perez JM, Gascue A. Tracheobronchopathia osteochondroplastica: helical CT findings in 4 cases. J Thorac Imaging 2004;19:112–116.PubMedCrossRefGoogle Scholar
- 79.Fraser RS, Colman N, Müller NL, Pare PD. Upper airway obstruction. In: Fraser and Pare’s Diagnosis of Diseases of the Chest, 4th Ed. Fraser RS, Colman N, Müller NL, Pare PD, Eds. W.B. Saunders Co, Philadelphia, 1999, p. 2042.Google Scholar
- 80.Shitrit D, Postinikov V, Grubstein A, et al. Accuracy of virtual bronchoscopy for grading tracheobronchial stenosis: correlation with pulmonary function test and fiberoptic bronchoscopy. Chest 2005;128:3545–3550.PubMedCrossRefGoogle Scholar
- 81.McAdams HP, Palmer SM, Erasmus JJ, et al. Bronchial anastomotic complications in lung transplant recipients: virtual bronchoscopy for noninvasive assessment. Radiology 1998;209:689–695.PubMedGoogle Scholar
- 82.Kim YH, Kim HT, Lee KS, Uh ST, Cung YT, Park CS. Serial fiberoptic bronchoscopic observations of endobronchial tuberculosis before and early after antituberculosis chemotherapy. Chest 1993;103:673–677.PubMedCrossRefGoogle Scholar
- 83.Kim Y, Lee KS, Yoon JH, et al. Tuberculosis of the trachea and main bronchi: CT findings in 17 patients. AJR Am J Roentgenol 1997;168:1051–1056.PubMedGoogle Scholar
- 84.McDonald TJ, Neel HB 3rd, DeRemee RA. Wegener’s granulomatosis of the subglottis and the upper portion of the trachea. Ann Otol Rhinol Laryngol 1982;91:588–592.PubMedGoogle Scholar
- 85.Langford CA, Sneller MC, Hallahan CW, et al. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener’s granulomatosis. Arthritis Rheum 1996;39:1754–1760.PubMedCrossRefGoogle Scholar
- 86.Hellmann D, Laing T, Petri M, Jacobs D, Crumley R, Stulbarg M. Wegener’s granulomatosis: isolated involvement of the trachea and larynx. Ann Rheum Dis 1987;46:628–631.PubMedGoogle Scholar
- 87.Daum TE, Specks U, Colby TV, et al. Tracheobronchial involvement in Wegener’s granulomatosis. Am J Respir Crit Care Med 1995;151:522–526.PubMedGoogle Scholar
- 88.Utzig MJ, Warzelhan J, Wertzel H, Berwanger I, Hasse J. Role of thoracic surgery and interventional bronchoscopy in Wegener’s granulomatosis. Ann Thorac Surg 2002;74:1948–1952.PubMedCrossRefGoogle Scholar
- 89.Screaton NJ, Sivasothy P, Flower CD, Lockwood CM. Tracheal involvement in Wegener’s granulomatosis: evaluation using spiral CT. Clin Radiol 1998;53:809–815.PubMedCrossRefGoogle Scholar
- 90.Cohen MI, Gore RM, August CZ, Ossoff RH. Tracheal and bronchial stenosis associated with mediastinal adenopathy in Wegener granulomatosis: CT findings. J Comput Assist Tomogr 1984;8:327–329.PubMedGoogle Scholar
- 91.Stein MG, Gamsu G, Webb WR, Stulbarg MS. Computed tomography of diffuse tracheal stenosis in Wegener granulomatosis. J Comput Assist Tomogr 1986;10:868–870.PubMedCrossRefGoogle Scholar
- 92.Summers RM, Aggarwal NR, Sneller MC, et al. CT virtual bronchoscopy of the central airways in patients with Wegener’s granulomatosis. Chest 2002;121:242–250.PubMedCrossRefGoogle Scholar
- 93.Cordier JF, Valeyre D, Guillevin L, Loire R, Brechot JM. Pulmonary Wegener’s granulomatosis. A clinical and imaging study of 77 cases. Chest 1990;97:906–912.PubMedCrossRefGoogle Scholar
- 94.Park KJ, Bergin CJ, Harrell J. MR findings of tracheal involvement in Wegener’s granulomatosis. AJR Am J Roentgenol 1998;171:524–525.PubMedGoogle Scholar