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Corcoran A, Foran A, Phinizy P, Biko DM, Piccione JC, Rapp JB. Dynamic airway computed tomography and flexible bronchoscopy for diagnosis of tracheomalacia in children: A comparison study. Pediatr Pulmonol 2024. [PMID: 38197524 DOI: 10.1002/ppul.26844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Tracheomalacia (TM) is an important cause of respiratory morbidity. Dynamic flexible bronchoscopy is considered the gold standard for diagnosis. Dynamic airway computed tomography (DACT) is a low radiation, noninvasive diagnostic tool utilizing images obtained continuously over several respiratory cycles. We aimed to assess the accuracy of DACT in TM diagnosis. METHODS Retrospective analysis of all patients who underwent both DACT and flexible bronchoscopy within 6 months. Airway anterior-posterior (AP) diameter was measured on multiplanar reconstructions CT in both the inspiratory and expiratory phases. Using still images from the bronchoscopy videos, the AP diameter of the trachea was measured at points of maximal and minimal diameter during tidal breathing. Degree of TM on both DACT and flexible bronchoscopy were graded using a scaling system of 50%-74%, 75%-89%, and 90%-100% as described by the European Respiratory Society. RESULTS Twenty-four patients met inclusion criteria with an average time of 19.5 days between CT and bronchoscopy. The specificity and sensitivity of DACT for the overall diagnosis of TM was 100% and 68%, respectively, with a positive predictive value of 100% and a negative predictive value of 62%. There was a strong positive correlation between DACT and flexible bronchoscopy in the measurement of tracheal AP diameter changes (ρ = 0.773, R2 0.597, p = 0.00001). Mean effective radiation dose for DACT was 0.1 mSv. CONCLUSION Ultralow dose DACT has excellent specificity and positive predictive value for both detection of TM and categorizing severity of tracheal collapse but is not sufficiently sensitive to rule it out.
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Affiliation(s)
- Aoife Corcoran
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann Foran
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pelton Phinizy
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph C Piccione
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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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: 16] [Impact Index Per Article: 8.0] [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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Cherian SV, Girvin F, Naidich DP, Machnicki S, Brown KK, Ryu JH, Gupta N, Mehta V, Estrada-Y-Martin RM, Narasimhan M, Oks M, Raoof S. Lung Hyperlucency: A Clinical-Radiologic Algorithmic Approach to Diagnosis. Chest 2019; 157:119-141. [PMID: 31356811 DOI: 10.1016/j.chest.2019.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as hyperlucent foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway, and vascular-related entities. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
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Affiliation(s)
- Sujith V Cherian
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Francis Girvin
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | | | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jay H Ryu
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Vishisht Mehta
- Division of Pulmonary Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rosa M Estrada-Y-Martin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care and Sleep Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Margarita Oks
- Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY
| | - Suhail Raoof
- Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY; Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY.
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High-pitch CT, decreasing need for sedation and its potential side effects: some practical considerations and future directions. Pediatr Radiol 2019; 49:297-300. [PMID: 30535876 DOI: 10.1007/s00247-018-4314-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022]
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5
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Winant AJ, Ngo AV, Phillips GS, Lee EY. Computed Tomography of Congenital Lung Malformations in Children: A Primer for Radiologists. Semin Roentgenol 2018; 53:187-196. [DOI: 10.1053/j.ro.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ullmann N, Secinaro A, Menchini L, Caggiano S, Verrillo E, Santangelo TP, Cutrera R, Tomà P. Dynamic expiratory CT: An effective non-invasive diagnostic exam for fragile children with suspected tracheo-bronchomalacia. Pediatr Pulmonol 2018; 53:73-80. [PMID: 29148213 DOI: 10.1002/ppul.23831] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/19/2017] [Accepted: 08/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tracheobronchomalacia, defined as variable collapse of the airways, has been recognized as an important cause of respiratory morbidity but still widely underdiagnosed. Bronchoscopy is still considered as the gold standard, but numerous limitations are known, especially for fragile sick children. Moreover, information on parenchymal lung disease cannot be described. There is a real need for a reliable, non-invasive test to help detection of airway and parenchymal malformations in children, specifically when bronchoscopy cannot be performed. METHODS AND RESULTS 34 paediatric patients underwent cine multidector CT for ongoing respiratory symptoms and were included. All CT images were of good quality and sedation was never needed. Airway disease such as trachea-broncomalacia with/without stenosis was described in 53% with the first being more frequent. Bronchomalacia alone was described in 10 patients and in 4 patients was associated with tracheomalacia. Moreover, CT allowed identification of parenchymal disease in 10 patients. Airways stenosis alone was detected in seven patients. The majority of patients (85%) underwent also bronchoscopy for clinical decision. The agreement between CT and bronchoscopy was explored. The two examinations did not agree only in two cases. CT dynamic showed an excellent sensitivity of 100% (81.47-100 %), a great specificity of 82% (48.22-97.72 %), NPV 100%, and PPV 90% (72-96.9 %). CONCLUSION Dynamic CT results an effective and highly sensitive diagnostic exam for children with tracheo-bronchomalacia. CT is especially indicated for those small and fragile patients that cannot undergo an invasive investigation. Moreover, CT allows a detailed evaluation both of the airways and the lungs which is useful for the clinical management.
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Affiliation(s)
- Nicola Ullmann
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Laura Menchini
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Serena Caggiano
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisabetta Verrillo
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Renato Cutrera
- Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Suwatanapongched T, Thongprasert C, Lertpongpiroon S, Muntham D, Kiatboonsri S. Expiratory air trapping during asthma exacerbation: Relationships with clinical indices and proximal airway morphology. Eur J Radiol 2015; 84:2671-8. [DOI: 10.1016/j.ejrad.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
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Konheim JA, Kon ZN, Pasrija C, Luo Q, Sanchez PG, Garcia JP, Griffith BP, Jeudy J. Predictive equations for lung volumes from computed tomography for size matching in pulmonary transplantation. J Thorac Cardiovasc Surg 2015; 151:1163-9.e1. [PMID: 26725712 DOI: 10.1016/j.jtcvs.2015.10.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/29/2015] [Accepted: 10/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Size matching for lung transplantation is widely accomplished using height comparisons between donors and recipients. This gross approximation allows for wide variation in lung size and, potentially, size mismatch. Three-dimensional computed tomography (3D-CT) volumetry comparisons could offer more accurate size matching. Although recipient CT scans are universally available, donor CT scans are rarely performed. Therefore, predicted donor lung volumes could be used for comparison to measured recipient lung volumes, but no such predictive equations exist. We aimed to use 3D-CT volumetry measurements from a normal patient population to generate equations for predicted total lung volume (pTLV), predicted right lung volume (pRLV), and predicted left lung volume (pLLV), for size-matching purposes. METHODS Chest CT scans of 400 normal patients were retrospectively evaluated. 3D-CT volumetry was performed to measure total lung volume, right lung volume, and left lung volume of each patient, and predictive equations were generated. The fitted model was tested in a separate group of 100 patients. The model was externally validated by comparison of total lung volume with total lung capacity from pulmonary function tests in a subset of those patients. RESULTS Age, gender, height, and race were independent predictors of lung volume. In the test group, there were strong linear correlations between predicted and actual lung volumes measured by 3D-CT volumetry for pTLV (r = 0.72), pRLV (r = 0.72), and pLLV (r = 0.69). A strong linear correlation was also observed when comparing pTLV and total lung capacity (r = 0.82). CONCLUSIONS We successfully created a predictive model for pTLV, pRLV, and pLLV. These may serve as reference standards and predict donor lung volume for size matching in lung transplantation.
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Affiliation(s)
- Jeremy A Konheim
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Zachary N Kon
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
| | - Qingyang Luo
- Division of Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, La
| | - Pablo G Sanchez
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jose P Garcia
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jean Jeudy
- Division of Thoracic Radiology, University of Maryland School of Medicine, Baltimore, Md
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Baez JC, Ciet P, Mulkern R, Seethamraju RT, Lee EY. Pediatric Chest MR Imaging. Magn Reson Imaging Clin N Am 2015; 23:337-49. [DOI: 10.1016/j.mric.2015.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Expiratory air trapping on thoracic computed tomography. A diagnostic subclassification. Ann Am Thorac Soc 2015; 11:874-81. [PMID: 24956379 DOI: 10.1513/annalsats.201311-390oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Multiple causes for air trapping as identified by expiratory computed tomography (CT) have been reported, but a unified evaluation schema has never been proposed. OBJECTIVES It was our purpose to identify imaging features that would help distinguish etiologies of mosaic air trapping. METHODS Cases with the term "air trapping" in the radiology report in 2010 were identified by searching the Radiology Information System of an academic tertiary care center and associated community hospital. Medical records and CT examinations were reviewed for the causes of air trapping. MEASUREMENTS AND MAIN RESULTS Causes for moderate to severe air trapping could be identified in 201 of 230 (87.4%) cases and could be subdivided into those associated with bronchiectasis (76 of 201, 38%), those associated with interstitial lung disease (62 of 201, 31%), those associated with tree-in-bud opacities (5 of 201, 2%), and those with air trapping alone (58 of 201, 29%). When found with bronchiectasis, nontuberculous mycobacteria, cystic fibrosis, idiopathic bronchiectasis, and transplant-related bronchiolitis obliterans were the most common causes of air trapping. When found with interstitial lung disease, sarcoidosis, hypersensitivity pneumonitis, or unspecified interstitial lung disease were the most common cause of air trapping. When found in isolation, chronic bronchitis, asthma, bronchiolitis obliterans, and unspecified small airways disease were the most common causes of air trapping. Unusual conditions causing isolated air trapping included vasculitis and diffuse idiopathic neuroendocrine cell hyperplasia. CONCLUSION A variety of conditions can cause air trapping. Associated imaging findings can narrow the differential diagnosis.
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Lee EY, Zucker EJ, Restrepo R, Daltro P, Boiselle PM. Advanced large airway CT imaging in children: evolution from axial to 4-D assessment. Pediatr Radiol 2013; 43:285-97. [PMID: 23417254 DOI: 10.1007/s00247-012-2470-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/09/2012] [Indexed: 12/13/2022]
Abstract
Continuing advances in multidetector computed tomography (MDCT) technology are revolutionizing the non-invasive evaluation of congenital and acquired large airway disorders in children. For example, the faster scanning time and increased anatomical coverage that are afforded by MDCT are especially beneficial to children. MDCT also provides high-quality multiplanar 2-dimensional (2-D), internal and external volume-rendering 3-dimensional (3-D), and dynamic 4-dimensional (4-D) imaging. These advances have enabled CT to become the primary non-invasive imaging modality of choice for the diagnosis, treatment planning, and follow-up evaluation of various large airway disorders in infants and children. It is thus essential for radiologists to be familiar with safe and effective techniques for performing MDCT and to be able to recognize the characteristic imaging appearances of large airway disorders affecting children.
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Affiliation(s)
- Edward Y Lee
- Departments of Radiology and Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Abstract
OBJECTIVE Wide-detector CT allows simultaneous imaging of the entire airway and lungs in small children. Images acquired in multiple phases by continuous scanning during respiration are viewed dynamically, allowing more complete airway and pulmonary evaluation than possible with static protocols. The purpose of this study was to evaluate whether low-dose techniques can be applied to dynamic pulmonary CT of small children. MATERIALS AND METHODS The study included 24 infants and small children with persistent respiratory difficulty who underwent dynamic pulmonary CT (11 with IV contrast administration, 13 without contrast administration). No significant difference in patient age was present in the two groups. Continuous-mode wide-detector scans were obtained at 350-millisecond gantry rotation for a total of 1.4 seconds at 80 kVp. Some contrast-enhanced studies for simultaneous vascular and airway evaluation were performed at slightly greater tube current. The effective dose for each patient was calculated, and the Student t test was performed to compare effective dose measurements. RESULTS All studies were of diagnostic quality, frequently yielding critical information not available with other diagnostic tests. The mean effective dose for all patients was 1.7 (SD, 1.1) mSv. In the group who received contrast material, the mean effective dose was greater (1.9 [SD, 1.4] mSv) than in the group who did not receive contrast material (1.5 [SD, 0.7] mSv), but the difference was not significant (p = 0.4). CONCLUSION Wide-detector dynamic CT is ideal for evaluation of the airway and lungs in infants and small children with persistent respiratory distress. Effective doses are low, typically less than 2 mSv.
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Tracheobronchomalacia in children: review of diagnosis and definition. Pediatr Radiol 2012; 42:906-15; quiz 1027-8. [PMID: 22426568 DOI: 10.1007/s00247-012-2367-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
Tracheobronchomalacia is characterised by excessive airway collapsibility due to weakness of airway walls and supporting cartilage. The standard definition requires reduction in cross-sectional area of at least 50% on expiration. However, there is a paucity of information regarding the normal range of central airway collapse among children of varying ages, ethnicities and genders, with and without coexisting pulmonary disease. Consequently, the threshold for pathological collapse is considered somewhat arbitrary. Available methods for assessing the airway dynamically--bronchoscopy, radiography, cine fluoroscopy, bronchography, CT and MR--have issues with reliability, the need for intubation, radiation dose and contrast administration. In addition, there are varying means of eliciting the diagnosis. Forced expiratory manoeuvres have been employed but can exaggerate normal physiological changes. Furthermore, radiographic evidence of tracheal compression does not necessarily translate into physiological or functional significance. Given that the criteria used to make the diagnosis of tracheobronchomalacia are poorly validated, further studies with larger patient samples are required to define the threshold for pathological airway collapse.
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Lee EY, Zurakowski D, Bastos MD, Stark C, Carrier M, Mason KP. Evaluation of image quality and patient safety: Paired inspiratory and expiratory MDCT assessment of tracheobronchomalacia in paediatric patients under general anaesthesia with breath-hold technique. J Med Imaging Radiat Oncol 2012; 56:151-7. [DOI: 10.1111/j.1754-9485.2012.02351.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Laya BF, Lee EY. Congenital Causes of Upper Airway Obstruction in Pediatric Patients: Updated Imaging Techniques and Review of Imaging Findings. Semin Roentgenol 2012; 47:147-58. [DOI: 10.1053/j.ro.2011.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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MCLAREN CLAREA, ROEBUCK DEREKJ. Imaging tracheobronchomalacia in the 21st century. J Med Imaging Radiat Oncol 2012; 56:129-31. [DOI: 10.1111/j.1754-9485.2012.02357.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee EY, Restrepo R, Dillman JR, Ridge CA, Hammer MR, Boiselle PM. Imaging Evaluation of Pediatric Trachea and Bronchi: Systematic Review and Updates. Semin Roentgenol 2012; 47:182-96. [DOI: 10.1053/j.ro.2011.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Paediatric multi-detector row chest CT: what you really need to know. Insights Imaging 2012; 3:229-46. [PMID: 22696085 PMCID: PMC3369117 DOI: 10.1007/s13244-012-0152-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/09/2012] [Accepted: 01/24/2012] [Indexed: 11/16/2022] Open
Abstract
Background The emergence of multi-detector row CT (MDCT) has established and extended the role of CT especially in paediatric chest imaging. This has altered the way in which data is acquired and is perceived as the 'gold standard' in the detection of certain chest pathologies. The range of available post-processing tools provide alternative ways in which CT images can be manipulated for review and interpretation in order to enhance diagnostic accuracy. Methodology Paediatric imaging technique/protocol together with radiation dose reduction is discussed in detail. The use of different post-processing tools to best demonstrate the wide range of important congenital anomalies and thoracic pathologies is outlined and presented pictorially. Conclusion MDCT with its isotropic resolution and fast imaging acquisition times reduces the need for invasive diagnostic investigations. However, users must be vigilant in their imaging techniques to minimise radiation burden, whilst maintaining good image quality. Main Messages • CT examinations should be clinically justified by the referring clinician and radiologist. • MDCT is invaluable for evaluating the central airway, mediastinal structures and lung parenchyma. • MDCT is more sensitive than plain radiographs in detection of structural changes within the lungs.
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Abstract
Cardiac multidetector computed tomography (MDCT) for congenital heart disease is a useful, rapid, and noninvasive imaging technique bridging the gaps between echocardiography, cardiac catheterization, and cardiac MRI. Fast scan speed and greater anatomic coverage, combined with flexible ECG-synchronized scans and a low radiation dose, are critical for improving the image quality of cardiac MDCT and minimizing patient risk. Current MDCT techniques can accurately evaluate extracardiac great vessels, lungs, and airways, as well as coronary arteries and intracardiac structures. Radiologists who perform cardiac MDCT in children should be familiarized with optimal cardiac computed tomography (CT) scan techniques and characteristic cardiac CT scan imaging findings.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea.
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Lee EY, Greenberg SB, Boiselle PM. Multidetector computed tomography of pediatric large airway diseases: state-of-the-art. Radiol Clin North Am 2011; 49:869-93. [PMID: 21889013 DOI: 10.1016/j.rcl.2011.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Advances in multidetector computed tomography (MDCT) technology have given rise to improvements in the noninvasive and comprehensive assessment of the large airways in pediatric patients. Superb two-dimensional and three-dimensional reconstruction MDCT images have revolutionized the display of large airways and enhanced the ability to diagnose large airway diseases in children. The 320-MDCT scanner, which provides combined detailed anatomic and dynamic functional information assessment of the large airways, is promising for the assessment of dynamic large airway disease such as tracheobronchomalacia. This article discusses imaging techniques and clinical applications of MDCT for assessing large airway diseases in pediatric patients.
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Affiliation(s)
- Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Children's Hospital Boston and Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA.
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