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Puri HV, Asaf BB, Mundale VV, Pulle MV, Bishnoi S, Munjal M, Kumar A, Kumar A. Predictors of Anastomotic Complications After Resection and Anastomosis for Tracheal Stenosis. Indian J Otolaryngol Head Neck Surg 2021; 73:447-454. [PMID: 34692457 DOI: 10.1007/s12070-020-02238-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022] Open
Abstract
Resection and anastomosis is an effective option for the management of complex tracheal stenosis, however, it's not without the complications. This study aims at evaluating various factors predicting anastomotic complications after trachea resection and anastomosis. This is a retrospective analysis of database from a dedicated thoracic surgical unit in New Delhi, India over 7 years. An analysis of demographic details, perioperative variables including complications were carried out. Analysis of various factors predicting anastomotic complications was performed. Out of 65 patients in the study, 49 (75.3%) were males and 16 (24.7%) were females. Median age of the patients was 31 years. Stenosis was cervical in 80%, cervico-thoracic in 15.4% and thoracic in 4.6% of patients. Median length of stenosis was 2.9 cm (1-4.2). 53 (81.6%) patients had some kind of preoperative intervention, where as rest 12 (18.4%) patients had no intervention at all. Out of 65 patients, 26 (40%) had crico-tracheal anastomosis while 39 (60%) had tracheo-tracheal anastomosis. Median length of resected tracheal segment was 3.3 cm (1-5). Overall complication rate (anastomotic + non-anastomotic) was 18.4% in which anastomosis related were in 4 (6.1%) patients. Resection of tracheal segment ≥ 3.5 cm, presence of diabetes mellitus and pre-operative use of corticosteroids were statistically significant factors for the onset of complications. Perioperative mortality rate was 1.5% (n = 1). Length of resection > 3.5 cm, presence of diabetes mellitus and pre-operative prolonged use of corticosteroids were significant predictors for the anastomotic complications.
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Affiliation(s)
- Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Vivek Vishwas Mundale
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Mohan Venkatesh Pulle
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
| | - Manish Munjal
- Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Akhil Kumar
- Department of ENT, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, Room No. 2328, SSRB, Old Rajinder Nagar, New Delhi, 110060 India
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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Ghirardo S, Porcaro F, Chiarini Testa MB, Paglietti MG, Ullmann N, El Hachem M, De Benedetti F, Cutrera R. A rare cause of multiple airways narrowing in a 15-year-old girl. Thorax 2020; 76:205-207. [PMID: 33273025 DOI: 10.1136/thoraxjnl-2020-216102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Sergio Ghirardo
- Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
| | - Maria Giovanna Paglietti
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
| | - May El Hachem
- Dermatology Unit, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
| | | | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesu Pediatric Hospital Department of Paediatrics, Roma, Italy
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Moser JB, Stefanidis K, Vlahos I. Imaging Evaluation of Tracheobronchial Injuries. Radiographics 2020; 40:515-528. [DOI: 10.1148/rg.2020190171] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Joanna B. Moser
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Stefanidis
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ioannis Vlahos
- From the Radiology Department, St James’s Wing, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom; and the Radiology Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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5
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Current Approach to Acute and Chronic Airway Disease. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-11149-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Theriault MM, Eddy K, Borgaonkar JN, Babar JL, Manos D. Diseases Involving the Central Bronchi: Multidetector CT for Detection, Characterization, and Differential Diagnosis. Radiographics 2018; 38:58-59. [PMID: 29320325 DOI: 10.1148/rg.2018170097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marie-Michele Theriault
- From the Department of Diagnostic Radiology, Université de Sherbrooke, Sherbrooke, Canada (M.M.T.); Department of Diagnostic Radiology, Dalhousie University, 1276 S Park St, PO Box 9000, Halifax, NS, Canada B3H 2Y9 (K.E., J.N.B., D.M.); and Department of Radiology, Addenbrooke's Hospital, Cambridge University, Cambridge, England (J.L.B.)
| | - Kathleen Eddy
- From the Department of Diagnostic Radiology, Université de Sherbrooke, Sherbrooke, Canada (M.M.T.); Department of Diagnostic Radiology, Dalhousie University, 1276 S Park St, PO Box 9000, Halifax, NS, Canada B3H 2Y9 (K.E., J.N.B., D.M.); and Department of Radiology, Addenbrooke's Hospital, Cambridge University, Cambridge, England (J.L.B.)
| | - Joy N Borgaonkar
- From the Department of Diagnostic Radiology, Université de Sherbrooke, Sherbrooke, Canada (M.M.T.); Department of Diagnostic Radiology, Dalhousie University, 1276 S Park St, PO Box 9000, Halifax, NS, Canada B3H 2Y9 (K.E., J.N.B., D.M.); and Department of Radiology, Addenbrooke's Hospital, Cambridge University, Cambridge, England (J.L.B.)
| | - Judith L Babar
- From the Department of Diagnostic Radiology, Université de Sherbrooke, Sherbrooke, Canada (M.M.T.); Department of Diagnostic Radiology, Dalhousie University, 1276 S Park St, PO Box 9000, Halifax, NS, Canada B3H 2Y9 (K.E., J.N.B., D.M.); and Department of Radiology, Addenbrooke's Hospital, Cambridge University, Cambridge, England (J.L.B.)
| | - Daria Manos
- From the Department of Diagnostic Radiology, Université de Sherbrooke, Sherbrooke, Canada (M.M.T.); Department of Diagnostic Radiology, Dalhousie University, 1276 S Park St, PO Box 9000, Halifax, NS, Canada B3H 2Y9 (K.E., J.N.B., D.M.); and Department of Radiology, Addenbrooke's Hospital, Cambridge University, Cambridge, England (J.L.B.)
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Barnes D, Gutiérrez Chacoff J, Benegas M, Perea RJ, de Caralt TM, Ramirez J, Vollmer I, Sanchez M. Central airway pathology: clinic features, CT findings with pathologic and virtual endoscopy correlation. Insights Imaging 2017; 8:255-270. [PMID: 28197883 PMCID: PMC5359148 DOI: 10.1007/s13244-017-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives To describe the imaging features of the central airway pathology, correlating the findings with those in pathology and virtual endoscopy. To propose a schematic and practical approach to reach diagnoses, placing strong emphasis on multidetector computed tomography (MDCT) findings. Methods We reviewed our thoracic pathology database and the central airway pathology-related literature. Best cases were selected to illustrate the main features of each disease. MDCT was performed in all cases. Multiplanar and volume-rendering reconstructions were obtained when necessary. Virtual endoscopy was obtained from the CT with dedicated software. Results Pathological conditions affecting the central airways are a heterogeneous group of diseases. Focal alterations include benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse abnormalities are divided into those that produce dilation and those that produce stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the mucosal layer and is an important diagnostic and therapeutic weapon. However, assessing the deep layers or the adjacent tissue is not possible. MDCT and post-processing techniques such as virtual bronchoscopy (VB) provide an excellent evaluation of the airway wall. Conclusion This review presents the complete spectrum of the central airway pathology with its clinical, pathological and radiological features. Teaching points • Dividing diseases into diffuse and focal lesions helps narrow the differential diagnosis. • Focal lesions with nodularity are more likely to correspond to tumours. • Focal lesions with stenosis are more likely to correspond to inflammatory disease. • Posterior wall involvement is the main feature in diffuse lesions with stenosis.
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Affiliation(s)
- Daniel Barnes
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | | | - Mariana Benegas
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Rosario J Perea
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Teresa M de Caralt
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Ramirez
- Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marcelo Sanchez
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Sims SEG, Li F, Lostracco T, Chaturvedi A, Son H, Wandtke J, Hobbs S. Multidimensional evaluation of tracheobronchial disease in adults. Insights Imaging 2016; 7:431-48. [PMID: 27085884 PMCID: PMC4877354 DOI: 10.1007/s13244-016-0489-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022] Open
Abstract
The large airways can be affected by a wide spectrum of acquired benign and malignant diseases. These lesions may present as focal or diffuse processes and with narrowing or widening of the airway. Some of these may be asymptomatic for quite some time and may be incidentally detected on imaging, while others may be symptomatic, causing airway compromise. There may be a characteristic radiograph and computed tomography (CT) appearance, suggesting a narrow differential. When the imaging findings are not definitive, tissue may be obtained for pathological analysis. It behooves the radiologist to be familiar with the pathologic findings that correlate with the radiographic or CT appearance of the most frequently seen large airway lesions. In this way, we may improve our diagnostic accuracy. This paper will present the imaging findings of the most prevalent tracheobronchial lesions along with any associated pathology. Teaching Points • The large airways can be affected by many acquired benign and malignant diseases.• Large airway lesions may present as focal or diffuse processes, with narrowing or widening.• There may or may not be characteristic imaging appearance of large airway disease.• If imaging findings are not definitive, tissue may be obtained for pathological analysis.
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Affiliation(s)
- Susan E. G. Sims
- />Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 USA
| | - Faqian Li
- />Department of Laboratory Medicine and Pathology, University of Minnesota, MMC 76, C420 Mayor Building, 420 Delaware Street, NE, Minneapolis, MN 55455 USA
| | - Thomas Lostracco
- />Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 USA
| | - Abhishek Chaturvedi
- />Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 USA
| | - Hongju Son
- />Department of Radiology, Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA 19141 USA
| | - John Wandtke
- />Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 USA
| | - Susan Hobbs
- />Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 USA
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10
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Shroff GS, Ocazionez D, Vargas D, Carter BW, Wu CC, Nachiappan AC, Gupta P, Restrepo CS. Pathology of the Trachea and Central Bronchi. Semin Ultrasound CT MR 2016; 37:177-89. [DOI: 10.1053/j.sult.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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11
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Ribeiro GMRE, Natal MRC, Silva EF, Freitas SC, Moraes WC, Maciel FC. Tracheobronchopathia osteochondroplastica: computed tomography, bronchoscopy and histopathological findings. Radiol Bras 2016; 49:56-7. [PMID: 26929463 PMCID: PMC4770399 DOI: 10.1590/0100-3984.2014.0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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12
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Jugpal TS, Garg A, Sethi GR, Daga MK, Kumar J. Multi-detector computed tomography imaging of large airway pathology: A pictorial review. World J Radiol 2015; 7:459-474. [PMID: 26753061 PMCID: PMC4697120 DOI: 10.4329/wjr.v7.i12.459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
The tracheobronchial tree is a musculo-cartilagenous framework which acts as a conduit to aerate the lungs and consequently the entire body. A large spectrum of pathological conditions can involve the trachea and bronchial airways. These may be congenital anomalies, infections, post-intubation airway injuries, foreign body aspiration or neoplasms involving the airway. Appropriate management of airway disease requires an early and accurate diagnosis. In this pictorial essay review, we will comprehensively describe the various airway pathologies and their imaging findings by multi-detector computed tomography.
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Shiau M, Harkin TJ, Naidich DP. Imaging of the central airways with bronchoscopic correlation: pictorial essay. Clin Chest Med 2015; 36:313-34, ix-x. [PMID: 26024607 DOI: 10.1016/j.ccm.2015.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A wide variety of pathologic processes, both benign and malignant, affect the central airways. These processes may be classified into 4 distinct groups: anatomic variants, lesions that result in focal or diffuse airway narrowing, and those that result in multinodular airway disorder. Key to the accurate assessment of the central airways is meticulous imaging technique, especially the routine acquisition of contiguous high-resolution, 1-mm to 1.5-mm images. These images enable high-definition axial, coronal, and sagittal reconstructions, as well as advanced imaging techniques, including minimum intensity projection images and virtual bronchoscopy. Current indications most commonly include patients presenting with signs and symptoms of possible central airway obstruction, with or without hemoptysis. In addition to diagnosing airway abnormalities, computed tomography (CT) also serves a critical complementary role to current bronchoscopic techniques for both diagnosing and treating airway lesions. Advantages of CT include noninvasive visualization of the extraluminal extent of lesions, as well as visualization of airways distal to central airways obstructions. As discussed and illustrated later, thorough knowledge of current bronchoscopic approaches to central airway disease is essential for optimal correlative CT interpretation.
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Affiliation(s)
- Maria Shiau
- Department of Radiology, Center for Biological Imaging, NYU-Langone Medical Center, 660 1st Avenue, New York, NY 10016, USA.
| | - Timothy J Harkin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - David P Naidich
- Department of Radiology, Center for Biological Imaging, NYU-Langone Medical Center, 660 1st Avenue, New York, NY 10016, USA
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Das K, Lababidi H, Al Dandan S, Raja S, Sakkijha H, Al Zoum M, AlDosari K, Larsson SG. Computed Tomography Virtual Bronchoscopy: Normal Variants, Pitfalls, and Spectrum of Common and Rare Pathology. Can Assoc Radiol J 2015; 66:58-70. [DOI: 10.1016/j.carj.2013.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/20/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
A broad spectrum of pathologies that involve the laryngotracheobronchial airway and imaging plays a crucial role in evaluating these abnormalities. Computed tomography with virtual bronchoscopy has been found to be very helpful in defining the location, extent, and nature of these lesions, and is increasingly being used even in patients with contraindications for fiberoptic bronchoscopy and laryngoscopy. Ionizing radiation, associated with virtual bronchoscopy, can be minimized by using low-dose multidetector computed tomography and hybrid iterative reconstruction techniques. Furthermore, retrospectively generated virtual bronchoscopy from a routinely acquired computed tomography data set eliminates additional cost and radiation. In the future, virtual bronchoscopy assisted with advanced navigational techniques will broaden the diagnostic and therapeutic landscape. This article presents the characteristic features of common and rare laryngotracheobronchial pathologies seen with virtual bronchoscopy.
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Affiliation(s)
- K.M. Das
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hani Lababidi
- Department of Pulmonary Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sadeq Al Dandan
- Department of Pathology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shanker Raja
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hussam Sakkijha
- Department of Pulmonary Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - Mohammad Al Zoum
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khalid AlDosari
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sven G. Larsson
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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15
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Laine M, Elfihri S, Kettani F, Bourkadi JE. Tracheobronchopathia osteochondroplastica associated with skin cancer: a case report and review of the literature. BMC Res Notes 2014; 7:637. [PMID: 25212226 PMCID: PMC4167286 DOI: 10.1186/1756-0500-7-637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/08/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause affecting the large airways. It is characterized by the accumulation of bony and cartilaginous nodules in the tracheal and bronchial mucosa. Approximately 300 cases of tracheobronchopathia osteochondroplastica have been reported since Wilks first identified it in 1857. Tomography and computed tomography scanning (CT) can be suggestive but final verification requires biopsy. Neoplastic disorders are, among others, blamed in etiology. We describe here, for the first time, a case of TO associated with skin cancer. CASE PRESENTATION A 40-year-old man with a scalp cancer was admitted for further evaluation of an occasional dry cough. Her medical history was otherwise unremarkable, and physical examination showed no abnormalities.The chest CT scan demonstrated multiple nodular densities in the trachea and proximal bronchi. The fiberoptic bronchoscopy showed multiple nodules in the trachea suggesting a malignant infiltration.Microscopic examination of the biopsy material revealed fragments of normal cartilage and bone formation with normal mucosa which confirmed the diagnosis of TO.Patient underwent surgery for scalp cancer. For TO, case has followed up. At twelve-month follow up, scalp tumor did not recur and cough ceased. CONCLUSION TO is a rare, benign disease that should be kept in mind especially in patients with tracheal irregularities in their chest imaging. Association with malignant tumors is reported.In patients with malignancy, TO can easily be misdiagnosed if it is not known as a diagnosis possibility of malignant invasion of the trachea. Therefore, it is important to be aware of this possibility, in order to prevent unnecessary treatments to patients.
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Affiliation(s)
- Mustapha Laine
- Departement of Pneumology, Moulay Youssef University Hospital Center, Faculty of Medicine and Pharmacy, Mohamed V University, 23 rue Belgrade, App 1, Ocean Rabat, Morocco.
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Barros Casas D, Fernández-Bussy S, Folch E, Flandes Aldeyturriaga J, Majid A. Non-malignant central airway obstruction. Arch Bronconeumol 2014; 50:345-54. [PMID: 24703501 DOI: 10.1016/j.arbres.2013.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/23/2013] [Accepted: 12/28/2013] [Indexed: 02/07/2023]
Abstract
The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumours and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.
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Affiliation(s)
- David Barros Casas
- Servicio de Neumología, Hospital Universitario La Paz, Madrid, España; Unidad de broncoscopias, Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Sebastian Fernández-Bussy
- Servicio de Neumología Intervencionista, Clínica Alemana-Universidad del Desarrollo de Chile, Santiago de Chile, Chile
| | - Erik Folch
- Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston. Estados Unidos
| | | | - Adnan Majid
- Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston. Estados Unidos.
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Focal Large Airway Anomalies and Abnormalities in Pediatric Patients. AJR Am J Roentgenol 2013; 201:W163-73. [DOI: 10.2214/ajr.12.9439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Tracheobronchial stenosis, narrowing of the airways by neoplastic or nonneoplastic processes, may be focal, as occurs with postintubation tracheal stenosis or a focal narrowing from a tumor, or more diffuse, such as those caused by inflammatory diseases. Symptoms develop when the narrowing impedes flow and increases resistance within the airways. Computed tomography defines the extent and severity of disease; endoscopy facilitates understanding of the cause so that an algorithm for treatment can be devised. Bronchoscopic interventions include balloons, ablative treatment, and stenting to provide symptomatic relief. Surgical resection may be curative and a multidisciplinary approach to tracheobronchial stenosis is required.
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Affiliation(s)
- Jonathan Puchalski
- Thoracic Interventional Program, Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, Laboratory of Clinical Investigation (LCI), New Haven, CT 06510, USA.
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Abstract
There are multiple etiologies for tracheal stenosis, postintubation stenosis being the most common. In this study, we briefly report a unique form of tracheal stenosis with circumferential calcification at the site of the lesion. The patient underwent multiple therapeutic bronchoscopies for palliation without much relief.
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Raess PW, Cowan SW, Haas AR, Zhang PJ, Litzky LA, Miller WT, Cooper JD, Deshpande CG. Tracheobronchopathia osteochondroplastica presenting as a single dominant tracheal mass. Ann Diagn Pathol 2011; 15:431-5. [PMID: 21778098 DOI: 10.1016/j.anndiagpath.2011.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/19/2011] [Accepted: 04/20/2011] [Indexed: 12/13/2022]
Abstract
Tracheobronchopathia osteochondroplastica is a rare, benign disorder of upper airways characterized by multiple submucosal metaplastic cartilaginous and bony nodules arising from the tracheal cartilage. We report an unusual presentation of tracheobronchopathia osteochondroplastica as a single dominant nodule arising from the anterior tracheal rings in a young adult man who presented with wheezing and symptoms of airway obstruction. The differential diagnosis of cartilaginous and bony endotracheal lesions is discussed.
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Affiliation(s)
- Philipp W Raess
- Department of Pathology and Laboratory Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA
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Snyder KD, Spaulding K, Edwards J. Imaging diagnosis--tracheobronchial zygomycosis in a cat. Vet Radiol Ultrasound 2010; 51:617-20. [PMID: 21158233 DOI: 10.1111/j.1740-8261.2010.01720.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tracheobronchial zygomycosis is described in a cat with acute dyspnea. Zygomycetes are an uncommon opportunistic group of pathogens, and few examples have been described in feline patients. Radiographic, ultrasonographic, and computed tomography imaging allowed identification of tracheobronchial masses, with intraluminal and peribronchial involvement. Surgical removal was impossible and antifungal chemotherapy was ineffective. Feline zygomycosis is a serious condition that should be considered when tracheobronchial masses are identified.
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Affiliation(s)
- Katherine D Snyder
- Department of Small Animal Clinical Sciences, Texas A&M University, TX 77843, USA.
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Cho A, Hur J, Kang WJ, Cho HJ, Lee JH, Yun M, Lee JD. Usefulness of FDG PET/CT in determining benign from malignant endobronchial obstruction. Eur Radiol 2010; 21:1077-87. [PMID: 21113598 DOI: 10.1007/s00330-010-2006-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/17/2010] [Accepted: 10/10/2010] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the usefulness of FDG PET/CT to differentiate malignant endobronchial lesions with distal atelectasis from benign bronchial stenosis. METHODS This retrospective study reviewed 84 patients who underwent contrast-enhanced chest CT and then PET/CT and had histological (n = 81) or follow-up imaging (n = 3) confirmation. Two chest radiologists reviewed initial chest CT and determined endobronchial lesions to be malignant or benign. Two nuclear medicine physicians reviewed PET/CT for FDG uptake at the obstruction site and measured SUV. Malignancy was considered when increased FDG uptake was seen in the obstruction site, regardless of FDG within the atelectatic lung. RESULTS The sensitivity, specificity and accuracy of chest CT was 95%, 48% and 84%, compared with 95%, 91% and 94% for PET/CT. Benign obstructive lesions showed statistically lower FDG uptake than malignant obstructions (benign SUV 2.5 ± 0.84; malignant SUV 11.8 ± 5.95, p < 0.001). ROC analysis showed an SUV cut-off value of 3.4 with highest sensitivity of 94% and specificity of 91%. CONCLUSION Increased FDG PET/CT uptake at the obstruction site indicates a high probability of malignancy, while benign lesions show low FDG uptake. Careful evaluation of FDG uptake pattern at the obstruction site is helpful in the differentiation between benign and malignant endobronchial lesions.
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Affiliation(s)
- Arthur Cho
- Division of Nuclear Medicine, Department of Radiology, Yonsei University Health System, 134 Shinchon-dong, Seodaemoon-ku, Seoul, South Korea
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Abstract
Tracheal stenosis may occur secondary to trauma, tumors, infection, inflammatory diseases, or iatrogenic causes. Understanding these lesions requires a basic understanding of the physics of airflow. All of these patients must be carefully evaluated and require a series of tests, including pulmonary function tests and radiographic studies. Treatment of tracheal lesions is a multidisciplinary issue and requires the close participation of interventional pulmonologists, anesthesiologists, and surgeons.
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Affiliation(s)
- Geraldine Daumerie
- Department of Anesthesiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Abstract
Tracheobronchial imaging has undergone a major revolution since the advent of MDCT. The improved spatial and temporal resolution not only allows reformatting images that enhance the comprehension of disease before bronchoscopy or surgery, it has introduced newer techniques such as dynamic expiratory imaging to evaluate for tracheomalacia, which can be a subtle, but a confounding entity for patients and clinician alike. Tracheobronchial diseases can be arbitrarily divided into those that cause focal and diffuse narrowing and widening. Such groupings can help develop a practical approach in evaluating diseases of the central airways.
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Affiliation(s)
- Cylen Javidan-Nejad
- Section of Cardiothoracic Imaging, Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St. Louis, MO 63110, USA.
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26
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Abstract
Tracheobronchial imaging has undergone a major revolution. The improved spatial and temporal resolution has introduced newer techniques such as dynamic expiratory imaging to evaluate for tracheomalacia. This article describes these techniques.
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Affiliation(s)
- Cylen Javidan-Nejad
- Section of Cardiothoracic Imaging, Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
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Kligerman S, Sharma A. Radiologic Evaluation of the Trachea. Semin Thorac Cardiovasc Surg 2009; 21:246-54. [DOI: 10.1053/j.semtcvs.2009.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2009] [Indexed: 02/08/2023]
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