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Aslam A, De Luis Cardenas J, Morrison RJ, Lagisetty KH, Litmanovich D, Sella EC, Lee E, Agarwal PP. Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Current Concepts and Future Directions. Radiographics 2022; 42:1012-1027. [PMID: 35522576 DOI: 10.1148/rg.210155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are airway abnormalities that share a common feature of expiratory narrowing but are distinct pathophysiologic entities. Both entities are collectively referred to as expiratory central airway collapse (ECAC). The malacia or weakness of cartilage that supports the tracheobronchial tree may occur only in the trachea (ie, tracheomalacia), in both the trachea and bronchi (TBM), or only in the bronchi (bronchomalacia). On the other hand, EDAC refers to excessive anterior bowing of the posterior membrane into the airway lumen with intact cartilage. Clinical diagnosis is often confounded by comorbidities including asthma, chronic obstructive pulmonary disease, obesity, hypoventilation syndrome, and gastroesophageal reflux disease. Additional challenges include the underrecognition of ECAC at imaging; the interchangeable use of the terms TBM and EDAC in the literature, which leads to confusion; and the lack of clear guidelines for diagnosis and treatment. The use of CT is growing for evaluation of the morphology of the airway, tracheobronchial collapsibility, and extrinsic disease processes that can narrow the trachea. MRI is an alternative tool, although it is not as widely available and is not used as frequently for this indication as is CT. Together, these tools not only enable diagnosis, but also provide a road map to clinicians and surgeons for planning treatment. In addition, CT datasets can be used for 3D printing of personalized medical devices such as stents and splints. An invited commentary by Brixey is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Anum Aslam
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Jose De Luis Cardenas
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Robert J Morrison
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Kiran H Lagisetty
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Diana Litmanovich
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Edith Carolina Sella
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Elizabeth Lee
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
| | - Prachi P Agarwal
- From the Department of Radiology, Division of Cardiothoracic Imaging (A.A., E.C.S., E.L., P.P.A.), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Section of Thoracic Surgery, Department of Surgery (J.D.L.C.), Department of Otolaryngology-Head and Neck Surgery (R.J.M.), Department of Surgery (K.H.L.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Surgery, Ann Arbor Veterans Hospital, Ann Arbor, Mich (K.H.L.); and Department of Radiology, Division of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (D.L.)
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