Spiral computed tomography with 3-dimensional reconstruction for the diagnosis of tracheobronchial stenosis

Role of spiral computed tomography with 3-dimensional reconstruction in cases with laryngeal stenosis--a radioclinical correlation

PURPOSE

To study the efficacy of spiral computed tomography with 3-dimensional reconstruction (SCT-3DI) and endoscopy in cases with laryngeal stenosis with regard to site, type, grade, and length of stenosis and to determine the correlation among the findings of SCT-3DI, endoscopy, and surgery.

MATERIAL AND METHODS

This prospective study on 30 cases of laryngotracheal stenosis (acquired = 28 cases, congenital = 2 cases) was conducted in the Department of Otorhinolaryngology and Head Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India, from 2001 to 2003. All patients were evaluated by SCT-3DI and rigid endoscopy. Twenty-three patients underwent open surgical procedure, and 7 patients underwent endoscopic dilatation. Correlation was established among the findings of SCT-3DI, endoscopy, and surgery by Pearson correlation coefficient (r), paired t test, and chi(2) test.

RESULTS

Findings of SCT-3DI, endoscopy, and surgery were found to well correlate with each other. SCT-3DI was found to be less accurate in measuring the exact length of stenosis but could measure the length of stenosis in all cases, whereas by endoscopy, the measurements could be made accurately in 14 cases (46.6%). The endoscopy was more accurate in diagnosing the site and grade of stenosis (P < .01). SCT-3DI gave 18.6% false-positive result regarding involvement of glottis in stenosis. A significant difference was found between endoscopy and SCT-3DI for grade III and IV stenoses (P < .01), and SCT-3DI found to give false-positive result in 19.2% cases for grade IV stenosis. SCT-3DI was found to be a better diagnosing modality in differentiating the circumferential Gupta and Parida. SCT-3DI was found to give a false-positive result in 19.2% cases for grade IV stenosis. SCT-3DI was found to be better a diagnosing modality in differentiating the circumferential and eccentric stenosis (P < .01) and to detect the cricoid and thyroid cartilage fracture, double stenosis, and laryngocele. A false-positive rate of 33.3% was seen in diagnosing fracture of cricoid cartilage on radiology.

CONCLUSION

The findings of SCT-3DI, endoscopy, and surgery well correlated with each other. Findings of SCT-3DI and rigid endoscopy are complementary to each other for a better surgical planning and outcome.

Slide tracheoplasty for congenital tracheal stenosis

BACKGROUND/PURPOSE

The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS.

METHODS

A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations.

RESULTS

A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation.

CONCLUSIONS

Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.