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Chen C, Tang F, Herth FJF, Zuo Y, Ren J, Zhang S, Jian W, Tang C, Li S. Building and validating an artificial intelligence model to identify tracheobronchopathia osteochondroplastica by using bronchoscopic images. Ther Adv Respir Dis 2024; 18:17534666241253694. [PMID: 38803144 PMCID: PMC11131396 DOI: 10.1177/17534666241253694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings. OBJECTIVES To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images. DESIGN We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation. METHODS Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs). RESULTS We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%. CONCLUSION We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease.
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Affiliation(s)
- Chongxiang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Fei Tang
- Department of Interventional Pulmonary and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui Province, China
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine and Translational Research Unit, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Yingnan Zuo
- Guangzhou Tianpeng Computer Technology Co., Ltd. Guangzhou, Guangdong, China
| | - Jiangtao Ren
- School of Computer Science and Engineering, Guangdong Province Key Lab of Computational Science, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuaiqi Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenhua Jian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Chunli Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province 510000, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province 510000, China
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Wang SN, Wu AS, Miao JB, Chen S, Jiang J. Airway management for a patient with tracheobronchomegaly undergoing lobectomy: a case report. BMC Anesthesiol 2023; 23:357. [PMID: 37919658 PMCID: PMC10621132 DOI: 10.1186/s12871-023-02324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Tracheobronchomegaly (TBM) is a rare disorder mainly characterized by dilatation and malacia of the trachea and major bronchi with diverticularization. This will be a great challenge for airway management, especially in thoracic surgery requiring one-lung ventilation. Using a laryngeal mask airway and a modified double-lumen Foley catheter (DFC) as a "blocker" may achieve one-lung ventilation. This is the first report introducing this method in a patient with TBM. CASE PRESENTATION We present a 64-year-old man with TBM receiving left lower lobectomy. Preoperative chest computed tomography demonstrated a prominent tracheobronchial dilation and deformation with multiple diverticularization. The most commonly used double-lumen tube or bronchial blocker could not match the distorted airways. After general anesthesia induction, a 4# laryngeal mask was inserted, through which the modified DFC was positioned in the left main bronchus with the guidance of a fiberoptic bronchoscope. The DFC balloon was inflated with 10 ml air and lung isolation was achieved without any significant air leak during one-lung or two-lung ventilation. However, the collapse of the non-dependent lung was delayed and finally achieved by low-pressure artificial pneumothorax. The surgery was successful and the patient was extubated soon after the surgery. CONCLUSIONS Using a laryngeal mask airway with a modified double-lumen Foley catheter acted as a bronchial blocker could be an alternative method to achieve lung isolation.
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Affiliation(s)
- Sai-Nan Wang
- Department of Anesthesiology, Beijing Chao-yang Hospital, Capital Medical University, Gongtinanlu 8#, Chaoyang, Beijing, 10020, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chao-yang Hospital, Capital Medical University, Gongtinanlu 8#, Chaoyang, Beijing, 10020, China
| | - Jin-Bai Miao
- Department of Thoracic surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Shuo Chen
- Department of Thoracic surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Anesthesiology, Beijing Chao-yang Hospital, Capital Medical University, Gongtinanlu 8#, Chaoyang, Beijing, 10020, China.
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Abali H. A rare case of rapidly progressive Tracheobronchopathia Osteochondroplastica. Respir Med Case Rep 2023; 43:101853. [PMID: 37124055 PMCID: PMC10131121 DOI: 10.1016/j.rmcr.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023] Open
Abstract
Tracheobronchopathia Osteochondroplastica (TO) is a rare benign disorder that is seldom progressive. Here, we report a case diagnosed with TO in our hospital. Bronchoscopy revealed multiple cartilaginous and ossifying nodules that are diagnostic for TO. Nodules protruding into the airways were observed as widespread and extended by the repeat bronchoscopy after 2 months of the diagnosis. TO was confirmed with the histopathology of the biopsies from nodules. Then he was referred to an interventional pulmonologist for laser ablation.
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Affiliation(s)
- Hulya Abali
- Kazlıcesme, 34020, Zeytinburnu, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
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A rare case of isolated laryngotracheal amyloidosis with airway narrowing and vocal fold involvement. Radiol Case Rep 2022; 17:4096-4099. [PMID: 36065250 PMCID: PMC9440355 DOI: 10.1016/j.radcr.2022.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Primary amyloidosis is a rare condition with 6-10 cases in a million, with focal involvement representing 9%-15% of those cases [1,2]. Isolated tracheobronchial amyloidosis is extremely rare and when present, can result in focal or diffuse thickening of the glottis, trachea and bronchi, leading to hoarseness, shortness of breath, and dysphonia. Computed tomography (CT) usually shows circumferential thickening of trachea and bronchi with or without calcifications and associated airway narrowing of affected segments. MRI demonstrates intermediate to low signal on T1, low signal on T2 and variable heterogeneous enhancement. Multiple conditions can result in thickening of the airway including but not limited to inflammatory, infectious, and neoplastic etiologies. Biopsy with histologic correlation provides a definitive diagnosis. Biopsied tissue demonstrates characteristic apple-green birefringence with Congo red stain. There is no cure for amyloidosis and the prognosis is quite variable depending on the extent of airway involvement. Current treatments are aimed at alleviating symptoms and include bronchoscopic debridement, laser therapy, and balloon dilation with adjuvant radiation therapy. Here, we present a rare case of a 47-year-old male with isolated laryngotracheal amyloidosis with marked airway narrowing and vocal fold involvement.
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Taniguchi H, Masaki Y, Tsuda T, Abo H, Muto A, Shimizu M, Takata N, Uchiyama A, Aikawa A, Ishizawa S. Tracheobronchitis in patients with diffuse wall thickening: Three case reports. Clin Case Rep 2022; 10:e5963. [PMID: 35702621 PMCID: PMC9178371 DOI: 10.1002/ccr3.5963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/24/2022] [Accepted: 05/16/2022] [Indexed: 11/12/2022] Open
Abstract
We herein report the cases of three patients with chest symptoms or fever and diffuse wall thickening of the trachea and main bronchi on chest CT. They were diagnosed with various causes of inflammations of the trachea and main bronchi using bronchial or tracheal biopsy specimens and flexible bronchoscopy.
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Affiliation(s)
- Hirokazu Taniguchi
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Yasuaki Masaki
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Takeshi Tsuda
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Hitoshi Abo
- Department of Diagnostic Radiology Toyama Prefectural Central Hospital Toyama Japan
| | - Atsushi Muto
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Mami Shimizu
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Naoki Takata
- Department of Respiratory Medicine Toyama Prefectural Central Hospital Toyama Japan
| | - Akio Uchiyama
- Department of Pathology Toyama Prefectural Central Hospital Toyama Japan
| | - Akane Aikawa
- Department of Pathology Toyama Prefectural Central Hospital Toyama Japan
| | - Shin Ishizawa
- Department of Pathology Toyama Prefectural Central Hospital Toyama Japan
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Choudhury S, Chohan A, Taweesedt PT, Dadhwal R, Vakil A. Coronavirus Disease 2019-Induced Tracheomegaly: A Case Report. Cureus 2022; 14:e23810. [PMID: 35518539 PMCID: PMC9067324 DOI: 10.7759/cureus.23810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Tracheomegaly is a medical condition where the tracheal diameter is greater than the upper limits of normal. Tracheomegaly can be classified as primary or secondary. Primary tracheomegaly is usually congenital. Secondary tracheomegaly can be due to multiple causes, including connective tissue disease, infections, autoimmune diseases like sarcoidosis, and prolonged mechanical ventilation. Here, we describe the first reported case of tracheomegaly secondary to coronavirus disease 2019 (COVID-19) pneumonia and COVID-induced interstitial lung disease (ILD). While many cases of tracheomegaly are asymptomatic, patients can have symptoms like cough, dyspnea, hemoptysis, or even respiratory failure. Tracheomegaly is associated with a higher risk of recurrent lower respiratory tract infections, chronic cough, bronchiectasis, and tracheobronchomalacia. Early recognition of COVID-19-induced tracheomegaly can help initial early management and reduce the incidence of infections.
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8
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Brandelik SC, Heussel CP, Kauczor HU, Röcken C, Huber L, Basset M, Kimmich C, Schönland SO, Hegenbart U, Nattenmüller J. CT features in amyloidosis of the respiratory system - Comprehensive analysis in a tertiary referral center cohort. Eur J Radiol 2020; 129:109123. [PMID: 32590259 DOI: 10.1016/j.ejrad.2020.109123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Amyloidosis of the respiratory system is rare and challenging since imaging findings have several more prevalent alternative diagnoses. We analyze and quantify chest CT findings in a large tertiary referral center patient cohort with confirmed amyloidosis of the respiratory system. METHODS 67 patients with histology-proven amyloidosis of the respiratory system and with available chest CT scans were retrospectively enrolled (years 2002-2018): 41 patients with local pulmonary parenchymal, 20 with local tracheobronchial, and 6 with systemic amyloidosis. CT was scored for findings like mass lesions, nodules, cysts, lymphadenopathy, calcifications and pleural, interstitial and tracheobronchial manifestations. Clinical data and imaging findings' frequencies among patients with local pulmonary parenchymal and tracheobronchial amyloidosis were compared. RESULTS Patients with local pulmonary parenchymal amyloidosis were older (67 vs. 56 years; P = 0.013) and less frequently symptomatic for cough (24% vs. 70%; P = 0.018) and bronchopulmonal infections (7% vs. 55%; P < 0.001) than patients with tracheobronchial amyloidosis. Local pulmonary parenchymal amyloidosis showed higher frequency of mass-like lesions (41% vs. 0%; P = 0.002) and nodules (95% vs. 20%; P < 0.001, with 10 or more nodules in 56% vs. 0%; P < 0.001 and predominantly pleura-associated in 32% vs. 0%; P = 0.02). Tracheobronchial amyloidosis leads to wall thickening of the bronchi (100% vs. 5%; P < 0.001) and the trachea (70% vs. 2%; P < 0.001). Systemic amyloidosis went along with a predominant alveolar septal pattern in 4 out of 6 patients. CONCLUSION Patients with local pulmonary parenchymal amyloidosis differ significantly from patients with tracheobronchial amyloidosis regarding clinical data and CT findings' frequencies. Being familiar with radiological manifestations of all three respiratory amyloidosis distribution patterns is essential to accelerate the diagnosis.
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Affiliation(s)
- Simone Christine Brandelik
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstrasse 1, 69126 Heidelberg, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University Kiel, Arnold-Heller-Str.3/14, 24105 Kiel, Germany
| | - Laura Huber
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marco Basset
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Christoph Kimmich
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Stefan Olaf Schönland
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, Hematology/Oncology/Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Amyloidosis Center, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Wang W, Hu H, Liu M, Wang J. Tracheobronchopathia Osteochondroplastica: Five Cases Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 99:NP111-NP118. [PMID: 32339049 DOI: 10.1177/0145561319897982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare disease. Here, we report 5 TO cases treated at our hospital. Bronchoscopy showed typical multiple firm and glossy nodules in all the 5 cases. Conservative treatment effectively alleviated the symptoms. Tracheobronchopathia osteochondroplastica is a manageable disease. Awareness in clinicians is critical to avoid unnecessary treatment in patients with TO.
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Affiliation(s)
- Weifang Wang
- Department of Respiratory Medicine, General Hospital of People's Liberation Army, Beijing, China
| | - Hong Hu
- Department of Respiratory Medicine, General Hospital of People's Liberation Army, Beijing, China
| | - Mei Liu
- Department of Pathology, General Hospital of People's Liberation Army, Beijing, China
| | - Jianxin Wang
- Department of Respiratory Medicine, General Hospital of People's Liberation Army, Beijing, China
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Kafili D, Sampson T, Tolhurst S. Difficult intubation in an asymptomatic patient with tracheobronchopathia osteochondroplastica. Respirol Case Rep 2020; 8:e00526. [PMID: 32025306 PMCID: PMC6996240 DOI: 10.1002/rcr2.526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/08/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare, benign, slowly progressive disease of unknown aetiology. It is characterized by numerous sessile, cartilaginous, or osseous submucosal nodules distributed throughout the anterolateral walls of the trachea and projecting into the laryngotracheobronchial lumen. The diagnosis is usually incidental with distinct bronchoscopic or computed tomography (CT) scan findings. We have identified a case of asymptomatic TO through fibreoptic bronchoscopy and biopsy after having a difficult intubation for elective prostate surgery.
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Affiliation(s)
- Dona Kafili
- Department of Respiratory MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - Timothy Sampson
- Department of AnaesthesiologyGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - Sean Tolhurst
- Department of Respiratory MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
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Nguyen TT, Melendez PE, Kaproth-Joslin K, Bhatt AA. Non-neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging. Insights Imaging 2019; 10:116. [PMID: 31802262 PMCID: PMC6893007 DOI: 10.1186/s13244-019-0790-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
The thoracic inlet is located at the crossroads between imaging of the neck and chest. It represents an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many important body systems are located within this region, including the enteric, respiratory, vascular, lymphatic, neurologic, and endocrine systems. A detailed examination of this region is essential when reviewing neck and thoracic imaging. This article will discuss the normal anatomic boundaries of the thoracic inlet and present an image-rich systematic discussion of the non-neoplastic pathology that can occur in this region. The neoplastic pathology of the thoracic inlet will be covered in a companion article.
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Affiliation(s)
- Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA.
| | - Patricia E Melendez
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | | | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Silveira MGM, Castellano MVCDO, Fuzi CE, Coletta ENAM, Spinosa GN. Tracheobronchopathia osteochondroplastica. J Bras Pneumol 2017; 43:151-153. [PMID: 28538784 PMCID: PMC5474380 DOI: 10.1590/s1806-37562016000000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/18/2016] [Indexed: 12/02/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica is a rare benign disease, of unknown cause, characterized by numerous sessile, cartilaginous, or bony submucosal nodules distributed throughout the anterolateral walls, projecting into the laryngotracheobronchial lumen. In general, tracheobronchopathia osteochondroplastica is diagnosed incidentally during bronchoscopy or autopsy and is not associated with a specific disease. We report the case of a male patient who was diagnosed with tracheobronchopathia osteochondroplastica via bronchoscopy and biopsy.
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Affiliation(s)
| | | | - Clarice Emiko Fuzi
- . Serviço de Doenças do Aparelho Respiratório, Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil
| | | | - Guilherme Nogueira Spinosa
- . Serviço de Doenças do Aparelho Respiratório, Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil
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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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Relapsing Polychondritis: an Update on Pathogenesis, Clinical Features, Diagnostic Tools, and Therapeutic Perspectives. Curr Rheumatol Rep 2015; 18:3. [PMID: 26711694 DOI: 10.1007/s11926-015-0549-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Helical computed tomography scanning of the larynx and upper trachea in rabbits. Acta Vet Scand 2015; 57:67. [PMID: 26427598 PMCID: PMC4590308 DOI: 10.1186/s13028-015-0157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Computed tomography (CT) is used to evaluate the human tracheobronchial tree because of its unsurpassed ability to visualize the airway and surrounding structures. To establish an ideal animal model for studying subglottic stenosis, we assessed the size and morphology of the normal rabbit’s laryngotracheal airway by helical CT. We measured luminal dimensions at the levels of the arytenoid and cricoid cartilages and the first, third, and eighth tracheal rings. At all levels, the axial slices were used to calculate the maximum anteroposterior (AP) dimension, transverse dimension, and cross-sectional areas. We measured the tracheal length from the cricoid to the third and eighth tracheal rings on sagittal reformation. We assessed the hyoid, thyroid, cricoid, arytenoid, and tracheal rings for the presence of calcific or soft tissue densities. We also addressed the presence or absence of pre-epiglottic and paraglottic fat. Results The mean AP tracheal dimension ± standard deviation (SD) was 8.6 ± 0.5 mm at the arytenoid level, 8.2 ± 0.7 mm at the cricoid level, and 7.7 ± 0.2 mm at the first tracheal ring level. The transverse tracheal dimension ±SD was 5.3 ± 0.1 mm at the arytenoid level, 5.5 ± 0.5 mm at the cricoid level, and 6.1 ± 0.6 mm at the first tracheal ring level. The mean tracheal area ±SD was 35.7 ± 2.2 mm2 at the arytenoid level, 35.8 ± 5.1 mm2 at the cricoid level, and 39.2 ± 4.3 mm2 at the first tracheal ring level. The tracheal length ±SD was 10.7 ± 2.3 mm from the cricoid to the third tracheal ring and 19.1 ± 1.14 mm to the eighth tracheal ring. There was complete calcification of the hyoid in all rabbits. Only two rabbits showed complete thyroid, arytenoid, or tracheal ring calcification. The remaining airway components were otherwise either uncalcified or partially calcified. The uvula, epiglottis, aryepiglottic fold, vallecula, piriform sinus, true/false vocal cords, and pre-epiglottic/paraglottic fat were not seen in any rabbit. Conclusions Helical CT investigation provides good, highly definitive anatomic details of the larynx and trachea in rabbits. Such results may be used in further evaluation of the normal airway and in cases of subglottic stenosis.
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Abstract
OBJECTIVE Recent technical advances, including the routine use of CT thin sections and techniques such as 2D minimum-intensity-projection and 3D volume images, have increased our ability to detect large airways diseases. Furthermore, dedicated CT protocols allow the evaluation of dynamic airway dysfunction. CONCLUSION With diseases of the large airways more commonly seen in daily practice, it is important that radiologists be familiar with the appearances, differential diagnosis, and clinical implications of these entities.
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Affiliation(s)
- Alexandre Dias Mançano
- MD, Radiologist, Radiologia Anchieta - Hospital Anchieta, Coordinator for Medical Residency at Hospital Regional de Taguatinga, Taguatinga, DF, Brazil
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Ulasli SS, Kupeli E. Tracheobronchopathia osteochondroplastica: a review of the literature. CLINICAL RESPIRATORY JOURNAL 2014; 9:386-91. [PMID: 24865333 DOI: 10.1111/crj.12166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/06/2014] [Accepted: 05/16/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tracheobronchopathia osteochondroplastica (TBPOCP) is an uncommon benign condition affecting the lumen of tracheobronchial tree and characterized by abnormal chondrification and ossification. TBPOCP is more frequent than it has been reported, as it can be asymptomatic or present with non-specific respiratory symptoms. AIMS In this article, we provide a review of the English literature on the condition and discuss its clinical features, general principles, diagnostic approaches and current treatment recommendations for TBPOCP. METHODS We searched for all papers indexed in Science Citation Index and Science Citation Index - Expanded by using Thomson Reuters Web of Knowledge Web of Science software. RESULTS We reviewed a total of 72 scientific publications. CONCLUSION In order to highlight, diagnosis, treatment and treatment outcomes of TBPOCP, further review articles and large case series about this orphan disease are needed.
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Affiliation(s)
- Sevinc Sarinc Ulasli
- Department of Pulmonary Diseases, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Elif Kupeli
- Department of Pulmonary Diseases, Faculty of Medicine, Baskent University, Ankara, Turkey
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Anchan SV, Garag SS, J S A, Prasad KC, Sharma PV. An interesting case of relapsing polychondritis in a young girl. J Clin Diagn Res 2013; 7:2976-7. [PMID: 24551697 DOI: 10.7860/jcdr/2013/6651.3815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/19/2013] [Indexed: 11/24/2022]
Abstract
Relapsing polychondritis is an acute, recurrent and progressive inflammation and degeneration of cartilage and connective tissue including that within the tracheobronchial tree affecting men and women equally and usually in the middle age. Serious airway manifestations occur in at least half of these patients. We present to you an interesting case report of a 20-year-old female who presented with exertional breathlessness. Imaging revealed diffuse calcification of pinna and tracheobronchial tree. Based on the characteristic clinical features and imaging studies a diagnosis of relapsing polychondritis was attained.
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Affiliation(s)
- Shibani V Anchan
- Assistant Professor, Department of Ear, Nose and Throat, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - Santosh S Garag
- Assistant Professor, Department of Ear, Nose and Throat, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - Arunkumar J S
- Professor, Department of Ear, Nose and Throat, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - K C Prasad
- Professor, Department of Ear, Nose and Throat, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
| | - Poorvi V Sharma
- Postgraduate, Department of Ear, Nose and Throat, SDM College of Medical Sciences and Hospital , Dharwad, Karnataka, India
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Eom JS, Lee G, Lee HY, Oh JY, Woo SY, Jeon K, Um SW, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Park HY. The relationships between tracheal index and lung volume parameters in mild-to-moderate COPD. Eur J Radiol 2013; 82:e867-72. [PMID: 24035456 DOI: 10.1016/j.ejrad.2013.08.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/09/2013] [Accepted: 08/10/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although elongated morphological changes in the trachea are known to be related to lung function in chronic obstructive pulmonary disease (COPD), whether the tracheal morphological changes are associated with airflow limitations or overinflation of the lung in the early stages of COPD has not yet been determined. Thus, our aim was to investigate the association of tracheal index (TI) with lung function parameters, including lung volume parameters, in COPD patients with mild-to-moderate airflow limitations. MATERIALS AND METHODS A retrospective study was conducted in 193 COPD patients with GOLD grades 1-2 (post-bronchodilator forced expiratory volume in 1s [FEV1] ≥ 50% predicted with FEV1/forced vital capacity ratio ≤ 70%; age range, 40-81) and 193 age- and gender-matched subjects with normal lung function as a control group (age range, 40-82). Two independent observers measured TI at three anatomical levels on chest radiographs and CT scans. RESULTS Compared with the control group, TI was reduced significantly and "saber-sheath trachea" was observed more frequently in COPD patients. Patients with GOLD grade 2 disease had a lower TI than those with GOLD grade 1. TI had apparent inverse correlations with total lung capacity, functional residual capacity, and residual volume, regardless of the anatomical level of the trachea. Even after adjustments for covariates, this association persisted. CONCLUSIONS TI is reduced even in mild-to-moderate COPD patients, and TI measured on chest CT shows significant inverse relationships with all lung volume parameters assessed, suggesting that tracheal morphology may change during the early stages of COPD.
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Affiliation(s)
- Jung Seop Eom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
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Tam MD, Laycock SD, Jayne D, Babar J, Noble B. 3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis. J Radiol Case Rep 2013; 7:34-43. [PMID: 24421951 DOI: 10.3941/jrcr.v7i8.1390] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This report concerns a 67 year old male patient with known advanced relapsing polychondritis complicated by tracheobronchial chondromalacia who is increasingly symptomatic and therapeutic options such as tracheostomy and stenting procedures are being considered. The DICOM files from the patient's dynamic chest CT in its inspiratory and expiratory phases were used to generate stereolithography (STL) files and hence print out 3-D models of the patient's trachea and central airways. The 4 full-sized models allowed better understanding of the extent and location of any stenosis or malacic change and should aid any planned future stenting procedures. The future possibility of using the models as scaffolding to generate a new cartilaginous upper airway using regenerative medical techniques is also discussed.
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Affiliation(s)
- Matthew David Tam
- Department of Radiology, Southend University Hospital NHS Foundation, Westcliff-on-Sea, Essex, UK ; P ostgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Stephen David Laycock
- East Anglian Radiography Research, Modelling and 3-D Printing Group, University Campus Suffolk, UK ; School of Computing Sciences, University of East Anglia, Norwich, UK
| | - David Jayne
- Department of Clinical Medicine, Addenbrookes Hospital NHS Trust, Cambridge, UK
| | - Judith Babar
- Department of Clinical Radiology, Addenbrookes Hospital NHS Trust, Cambridge, UK
| | - Brendon Noble
- School of Science, Technology and Health, University Campus Suffolk, Ipswich, UK
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Jindal S, Nath A, Neyaz Z, Jaiswal S. Tracheobronchopathia osteochondroplastica--a rare or an overlooked entity? J Radiol Case Rep 2013; 7:16-25. [PMID: 23705042 DOI: 10.3941/jrcr.v7i3.1305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica is an idiopathic non-malignant disease of large airways featured by submucosal cartilaginous to osseous nodules overlying the cartilaginous rings, which may be focal or diffuse. Clinical presentation varies from asymptomatic to symptoms like breathlessness, recurrent chest infections, cough and hemoptysis. Due to the lack of awareness of this disease, it remains an under recognized entity. We are describing the computed tomography and bronchoscopic findings of two recently diagnosed cases at our institute. The purpose of this report is to familiarize radiologists with imaging appearance of this condition, with the goal of increasing clinical suspicion of this uncommon condition.
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Affiliation(s)
- Shikha Jindal
- Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Multidetector-row Computed Tomography of Diffuse Tracheal Disease: Pictorial Review. J Bronchology Interv Pulmonol 2012; 16:28-36. [PMID: 23168465 DOI: 10.1097/lbr.0b013e318195e1e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Diffuse tracheal diseases are uncommon and may mimic asthma or other forms of chronic obstructive lung disease. Bronchoscopy is usually definitive in establishing a diagnosis and assessing the severity of diffuse tracheal disease. However, advances in multidetector-row computed tomography (MDCT) technology allow for rapid acquisition time and generation of high-quality multiplanar reconstructions and virtual bronchoscopic images, making MDCT evaluation of suspected or known tracheal disease the noninvasive examination of choice. The MDCT findings of the various diseases that diffusely affect the trachea may be highly suggestive of 1 particular disease or narrow the differential diagnosis to a few possibilities. Moreover, MDCT imaging of the chest can help identify associated lung disease or complications of diffuse tracheal disease such as pneumonia or atelectasis. This pictorial review illustrates the MDCT appearances of the more common diffuse tracheal diseases.
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Abstract
Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare disorder characterized by marked dilatation of the trachea and main bronchi, bronchiectasis, and recurrent respiratory tract infections. The etiology of this disorder is uncertain and the clinical presentation is variable. The diagnosis is usually made on the basis of the characteristic CT scan findings. We report a case in a 21-year-old man presenting with recurrent lower respiratory tract infections.
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Affiliation(s)
- Satish Kachhawa
- Department of Radiodiagnosis, Sardar Patel Medical College, Bikaner, India
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25
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Sosa Lozano LA, Shahir K, Akbar M, Goodman LR. A case of tracheal varices: an unusual but important cause of mural nodules in the trachea. Br J Radiol 2011; 84:e62-4. [PMID: 21325360 DOI: 10.1259/bjr/23728020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tracheal varices (TV) are uncommon but can be an important source of massive or recurrent haemoptysis. We present a case of TV in a 32-year-old patient with a history of Glenn-Fontan surgery, for congenital tricuspid atresia, and portal hypertension owing to cardiac cirrhosis. We discuss TV presenting as tracheal nodules in the presence of extensive mediastinal collateral circulation.
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Affiliation(s)
- L A Sosa Lozano
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Ahn HS, Hwang JH, Chang YW, Kim HJ, Kwon KH, Choi DL. Pictorial Review of Diffuse Central Airway Diseases: Focus on CT Findings. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Shin Ahn
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kui Hyang Kwon
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Deuk Lin Choi
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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28
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Mounier-Kuhn Syndrome. J Bronchology Interv Pulmonol 2010; 17:362-4. [DOI: 10.1097/lbr.0b013e3181f43172] [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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31
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Kim EY, Kim TS, Choi JY, Han J, Kim H. Multiple tracheal metastases of lung cancer: CT and integrated PET/CT findings. Clin Radiol 2010; 65:493-5. [PMID: 20451018 DOI: 10.1016/j.crad.2010.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/07/2010] [Accepted: 01/21/2010] [Indexed: 11/18/2022]
Affiliation(s)
- E Y Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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32
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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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Colt H, Murgu SD, Ahn YC, Brenner M. Multimodality bronchoscopic [corrected] imaging of tracheopathica osteochondroplastica. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:034035. [PMID: 19566328 DOI: 10.1117/1.3155524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Results of a commercial optical coherence tomography system used as part of a multimodality diagnostic bronchoscopy platform are presented for a 61-year-old patient with central airway obstruction from tracheopathica osteochondroplastica. Comparison to results of white-light bronchoscopy, histology, and endobronchial ultrasound examination are accompanied by a discussion of resolution, penetration depth, contrast, and field of view of these imaging modalities. White-light bronchoscopy revealed irregularly shaped, firm submucosal nodules along cartilaginous structures of the anterior and lateral walls of the trachea, sparing the muscular posterior membrane. Endobronchial ultrasound showed a hyperechoic density of 0.4 cm thickness. optical coherence tomography (OCT) was performed using a commercially available, compact time-domain OCT system (Niris System, Imalux Corp., Cleveland, Ohio) with a magnetically actuating probe (two-dimensional, front imaging, and inside actuation). Images showed epithelium, upper submucosa, and osseous submucosal nodule layers corresponding with histopathology. To our knowledge, this is the first time these commercially available systems are used as part of a multimodality bronchoscopy platform to study diagnostic imaging of a benign disease causing central airway obstruction. Further studies are needed to optimize these systems for pulmonary applications and to determine how new-generation imaging modalities will be integrated into a multimodality bronchoscopy platform.
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Affiliation(s)
- Henri Colt
- University of California School of Medicine, Pulmonary and Critical Care Medicine, Department of Medicine, 101 the City Drive South, Building 53, Room 119, Route 81 Orange, California 92868, USA.
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Ernst A, Rafeq S, Boiselle P, Sung A, Reddy C, Michaud G, Majid A, Herth FJF, Trentham D. Relapsing polychondritis and airway involvement. Chest 2008; 135:1024-1030. [PMID: 19017885 DOI: 10.1378/chest.08-1180] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence and characteristics of airway involvement in relapsing polychondritis (RP). METHODS Retrospective chart review and data analysis of RP patients seen in the Rheumatology Clinic and the Complex Airway Center at Beth Israel Deaconess Medical Center from January 2004 through February 2008. RESULTS RP was diagnosed in 145 patients. Thirty-one patients had airway involvement, a prevalence of 21%. Twenty-two patients were women (70%), and they were between 11 and 61 years of age (median age, 42 years) at the time of first symptoms. Airway symptoms were the first manifestation of disease in 17 patients (54%). Dyspnea was the most common symptom in 20 patients (64%), followed by cough, stridor, and hoarseness. Airway problems included the following: subglottic stenosis (n = 8; 26%); focal and diffuse malacia (n = 15; 48%); and focal stenosis in different areas of the bronchial tree in the rest of the patients. Twelve patients (40%) required and underwent intervention including balloon dilatation, stent placement, tracheotomy, or a combination of the above with good success. The majority of patients experienced improvement in airway symptoms after intervention. One patient died during the follow-up period from the progression of airway disease. The rest of the patients continue to undergo periodic evaluation and intervention. CONCLUSION In this largest cohort described in the English language literature, we found symptomatic airway involvement in RP to be common and at times severe. The nature of airway problems is diverse, with tracheomalacia being the most common. Airway intervention is frequently required and in experienced hands results in symptom improvement.
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Affiliation(s)
- Armin Ernst
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Samaan Rafeq
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Phillip Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Arthur Sung
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Chakravarthy Reddy
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Gaetane Michaud
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Adnan Majid
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - David Trentham
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA
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Abu-Hijleh M, Lee D, Braman SS. Tracheobronchopathia Osteochondroplastica: A Rare Large Airway Disorder. Lung 2008; 186:353-9. [DOI: 10.1007/s00408-008-9113-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 07/31/2008] [Indexed: 11/30/2022]
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Neurofibromatosis type 1 with tracheobronchial neurofibromas: case report with emphasis on tomographic findings. J Thorac Imaging 2008; 23:194-6. [PMID: 18728548 DOI: 10.1097/rti.0b013e31816b6bc0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 65-year-old man with neurofibromatosis type 1 (NF-1) presented with a 3-month history of dyspnea and cough. The chest spiral computed tomography scan showed multiple neurofibromas in the larynx and tracheobronchial tree. Bronchoscopy was performed and the biopsy confirmed the diagnosis of benign neurofibroma. The upper airway involvement in NF-1 is rare, and the diagnosis on the basis of the clinical manifestation may be difficult. The clinical manifestations of patients with tracheobronchial neurofibromas are mostly related to airway obstruction, presenting with cough, wheezing, and dyspnea. Our case illustrates the value of spiral computed tomography imaging in providing an excellent anatomic definition of this rare manifestation of NF.
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Marchiori E, Pozes AS, Souza Junior AS, Escuissato DL, Irion KL, Araujo Neto CD, Barillo JL, Souza CA, Zanetti G. Alterações difusas da traquéia: aspectos na tomografia computadorizada. J Bras Pneumol 2008; 34:47-54. [DOI: 10.1590/s1806-37132008000100009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/01/2007] [Indexed: 12/22/2022] Open
Abstract
O objetivo deste ensaio pictórico foi apresentar as principais alterações tomográficas observadas em doenças que acometem a traquéia de forma difusa. As doenças estudadas foram amiloidose, traqueobroncopatia osteocondroplástica, traqueobroncomegalia, papilomatose laringo-traqueo-brônquica, linfoma, neurofibromatose, policondrite recidivante, granulomatose de Wegener, tuberculose, paracoccidioidomicose e traqueobroncomalácia. O principal aspecto observado na tomografia computadorizada foi o espessamento das paredes traqueais, com ou sem nodulações, calcificações parietais ou comprometimento da parede posterior. Embora a tomografia computadorizada permita a detecção e a caracterização das doenças das vias aéreas centrais, e a correlação com os dados clínicos reduza as possibilidades diagnósticas, a broncoscopia com biópsia continua sendo o procedimento mais importante no diagnóstico das lesões difusas da traquéia.
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Ferretti GR, Pison C, Righini C. [Volume CT: recent advances in acquired abnormalities of the trachea]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2007; 124:136-47. [PMID: 17481569 DOI: 10.1016/j.aorl.2007.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 01/29/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To show the recent improvements in CT imaging of the trachea due to the introduction of multidetector computed tomography (MDCT). MATERIAL AND METHODS MDCT technology, which was introduced in the early 00's, allows acquiring the entire airways within few seconds while using low dose parameters thanks to the natural high contrast of the airways. RESULTS Volume acquisition with isotropic voxels offers an excellent anatomical resolution in all directions, improving the quality of multiplanar reformations and 3D reconstructions, including virtual bronchoscopy. Therefore, the ability of CT for detecting and localizing tracheal abnormalities are improved, which is useful for planning endoscopy or open surgery, or assess their results. Dynamic acquisition during expiration is the last refinement permitted by MDCT, which is of value to detect tracheomalacia. CONCLUSIONS MDCT is a non-invasive technique to image the trachea. Its applications are numerous, such as depiction of anatomical or functional abnormalities, evaluation of local extent of the disease, planning and assessing open surgery or interventional endoscopy.
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Affiliation(s)
- G-R Ferretti
- Service central de radiologie et imagerie médicale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Lee KS, Ernst A, Trentham DE, Lunn W, Feller-Kopman DJ, Boiselle PM. Relapsing Polychondritis: Prevalence of Expiratory CT Airway Abnormalities. Radiology 2006; 240:565-73. [PMID: 16801364 DOI: 10.1148/radiol.2401050562] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To retrospectively determine the prevalence of expiratory computed tomographic (CT) abnormalities, including malacia and air trapping, in patients with relapsing polychondritis and to retrospectively determine the frequency with which expiratory abnormalities are accompanied by inspiratory abnormalities on CT scans. MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was not required for this retrospective HIPAA-compliant study. A computerized hospital information system was used to identify all patients with clinically diagnosed or biopsy-proved relapsing polychondritis who were referred for CT airway imaging during a 17-month period. The study cohort comprised 18 patients (15 women, three men; mean age, 47 years; age range, 20-71 years). Multidetector helical CT was performed in all patients by using a standard protocol, which included end-inspiratory and dynamic expiratory volumetric imaging. Two observers who were blinded to the original scan interpretations simultaneously reviewed CT scans. Findings were recorded in consensus. Dynamic expiratory CT scans were assessed for malacia that involved the trachea and main bronchi (reduction in cross-sectional area of more than 50%) and for air trapping (failure of lung parenchyma to increase in attenuation during expiration). Air trapping was visually classified according to pattern and extent (lobular, segmental, lobar, or whole lung). Inspiratory CT scans were evaluated for tracheal and bronchial stenosis (>25% luminal diameter narrowing compared with a corresponding uninvolved segment), wall thickening (>2 mm), and calcification. RESULTS Expiratory CT abnormalities were present in 17 (94%) of 18 patients and included malacia in 13 patients (72%) and air trapping in 17 patients (94%). Inspiratory CT abnormalities were found in eight (47%) of 17 patients who had expiratory CT abnormalities. Calcification of the airway walls was present in seven (39%) of 18 patients. All patients who had inspiratory CT abnormalities demonstrated expiratory CT abnormalities. CONCLUSION Expiratory CT abnormalities were present in the majority of patients with relapsing polychondritis who were referred for airway imaging, yet only half of these patients demonstrated abnormalities on routine inspiratory CT scans. Thus, dynamic expiratory CT should be a standard component of imaging assessment in patients with relapsing polychondritis.
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Affiliation(s)
- Karen S Lee
- Department of Radiology, Center for Airway Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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Tadjeddein A, Khorgami Z, Akhlaghi H. Tracheobronchopathia osteoplastica: cause of difficult tracheal intubation. Ann Thorac Surg 2006; 81:1480-2. [PMID: 16564296 DOI: 10.1016/j.athoracsur.2005.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 04/02/2005] [Accepted: 04/05/2005] [Indexed: 11/22/2022]
Abstract
Tracheobronchopathia osteochondroplastica is a rare benign disorder affecting the trachea and the bronchi. We report a case presenting as difficulty during tracheal intubation. Chest roentgenogram revealed nothing before surgery. Findings on computed tomographic imaging scans show calcified nodular densities protruding into the tracheal lumen, with an abnormally irregular tracheal morphology and decreased lateral diameter. The fiber optic bronchoscopy, which was unable to pass more than 4 to 5 cm, showed enormous prominent protrusion with significant narrowing of the tracheal lumen. The diagnosis was confirmed by virtual bronchoscopy, which showed a tracheal narrowing with a beaded appearance and an irregular border that extended into the trachea and main bronchi.
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Affiliation(s)
- Ahmad Tadjeddein
- Thoracic Surgery Ward, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Fortuna FP, Irion K, Wink C, Boemo JL. Síndrome de Mounier-Kühn. J Bras Pneumol 2006; 32:180-3. [PMID: 17273589 DOI: 10.1590/s1806-37132006000200015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 06/16/2005] [Indexed: 11/22/2022] Open
Abstract
A síndrome de Mounier-Kühn, ou traqueobroncomegalia congênita, é uma entidade clínica rara caracterizada pela dilatação anormal de traquéia e brônquios principais. O diagnóstico geralmente pode ser realizado através da mensuração do diâmetro traqueal. Os autores apresentam o caso de um homem de 40 anos com pneumonia refratária ao tratamento, no qual a traqueobroncomegalia foi confirmada através de tomografia computadorizada.
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Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP. Relapsing polychondritis affecting the lower respiratory tract. AJR Am J Roentgenol 2002; 178:173-7. [PMID: 11756115 DOI: 10.2214/ajr.178.1.1780173] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the CT findings of lower respiratory tract involvement by relapsing polychondritis. CONCLUSION The most common CT manifestations were increased attenuation and smooth thickening of airway walls. Tracheal or bronchial stenosis was less common. Airway collapse and lobar air trapping were seen in half of patients examined with expiratory CT.
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Affiliation(s)
- Jeffrey V Behar
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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Abstract
Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases in the United States are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young and present with signs and symptoms of obstruction or compression of the superior vena cava, pulmonary veins or arteries, central airways, or esophagus. There may be two types of fibrosing mediastinitis: focal and diffuse. The focal type usually manifests on computed tomographic (CT) or magnetic resonance (MR) images as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests on CT or MR images as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. CT and MR imaging play a vital role in the diagnosis and management of fibrosing mediastinitis.
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Affiliation(s)
- S E Rossi
- Deprtment of Radiology, Buenos Aires, Argentina
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