Airways Disease

PGI Justin Ng Sinco

TRACHEA & CENTRAL BRONCHI

Congenital Tracheal AnomaliesFocal Tracheal DiseaseDiffuse Tracheal DiseaseTracheal & Bronchial injuryBroncholithiasis

CONGENITAL TRACHEAL ANOMALIES

TracheocelesTracheal bronchus

Tracheocele

• “Paratracheal air cyst”• True diverticula• Herniation though a

weakened posterior tracheal membrane– Cervical trachea

• Fluoroscopy, CT, contrast tracheogram

Acta Otorrinolaringol Esp. 2009;60(05):378

Tracheal bronchus

• “Bronchus suis”; Pig bronchus

• Accessory bronchus to the right upper lobe– 2cm of the tracheal

carina

Case courtesy of Radiopaedia.org, rID: 12027

Fundamentals of Diagnostic Radiology

FOCAL TRACHEAL DISEASE

NarrowingDilatation

Extrinsic Compression/Narrowing

• Extrinsic compression– Intrathoracic goiter– Large paratracheal lymph node mass

• Extrinsic masses displace the trachea without narrowing the lumen

Intrathoracic goiter displacing the trachea

Focal Tracheal Stenosis

• Inflammatory disorders• Tracheomalacia– Tracheostomy– Endotracheal tube cuff

• Hourglass deformity

http://www.eurorad.org/eurorad/case.php?id=815

Focal Tracheal StenosisTRACHEOMALACIA Narrowing CauseExtrathoracic Inspiration Prior tracheostomyIntrathoracic Expiration Prior endotracheal intubation

Case courtesy of Dr Frank Gaillard, Radiopaedia.org, rID: 8572

Inspiration Expiration

Focal Tracheal Stenosis

• Wegener’s Granulomatosis

http://www.scielo.br/

Focal Tracheal Stenosis

• Infectious causes– Tuberculosis– Fungus– Scleroma

http://www.appliedradiology.com/

Scleroma

Focal Tracheal Dilataion

• Congenital– Tracheocele

• Acquired– Endotracheal intubation– Tracheal traction

DIFFUSE TRACHEAL DISEASE

NarrowingDilatation

DIFFUSE TRACHEAL NARROWING

Saber-sheath TracheaAmyloidosisTracheobronchopathia osteochondroplasticaRelapsing polychondritisTracheal scleroma

Saber-sheath Trachea

• Side-to-side narrowing– Coronal diameter < 2/3 of sagittal diameter

• Uniform thickening of tracheal wall & calcification of rings

• Older men with COPD

Saber-sheath Trachea

Case courtesy of Dr Andrew Ho, Radiopaedia.org, rID: 28522

Amyloidosis

• Fibrillar protein-polysaccharide (amyloid) depositions

• Localized or systemic– Localized: submucosal

deposits in the tracheo broncial tree; with nodular or alveolar septal deposits

http://pathhsw5m54.ucsf.edu/

Tracheobronchopathia osteochondroplastica

• Multiple submucosal osseous & carttilaginous deposits

• Elderly men• Sparing of the posterior

mebranous wall– Ddx vs amyloidosis

Case courtesy of Dr Dalia Ibrahim, Radiopaedia.org, rID: 38397

Relapsing Polychondritis

• Autoimmune disorder– Earlobes, nose, larynx,

tracheobronchial tree, joints, large arteries

• Tracheal dilation then fixed narrowing– Cartilage destruction

then fibrosis

Case courtesy of Dr Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 31793

DIFFUSE TRACHEAL DILATATION

TracheobronchomegalyTrachebronchomalacia

Tracheobronchomegaly(Mounier-Kuhn syndrome)

• Male less than 50 yo• Central bronchial

collapse during coughing

• Frontal radiograph– Trachea > 3.0cm– Central bronchi > 2.5cm

• Corrugated trachea

Case courtesy of Dr Stefan Götschi, Radiopaedia.org, rID: 14894

Tracheobronchomalacia

• Congenital• Acquired– COPD– Chronic bronchitis– Cystic fibrosis– Relapsing polychondritis

• Similar to tracheobronchomegaly

Tracheal & Bronchial Injury

• Pneumothorax and pneumomediastinum– Pneumothorax non-

responsive to chest tube drainage

• “Fallen lung” sign

Tracheal & Bronchial InjuryINJURY CAUSE

Horizontal laceration or transection parallel to tracheobronchial cartilage

Blunt chest trauma (deceleration-type injury)

Penetrating injury involving cervical trachea

Gunshot or stab wound to the neck

Pentrating injury to the intrathoracic trachea

Fatal penetrating cardiovascular injury

http://www.archbronconeumol.org/en/medical-and-surgical-management-of/articulo/13075318/

BRONCHOLITHIASIS

Broncholithiasis

• Calcified material within the tracheobronchial tree– Calcified peribronchial lymph node erosion• Tuberculosis or histoplasmosis

– Bronchiectasis, obstructive atelectasis, pneumonia, hemoptysis

Broncholithiasis

http://learningradiology.com/

COPD

AsthmaChronic BronchitisBronchiectasisEmphysema

ASTHMA & CHRONIC BRONCHITIS

Asthma

• Hyperinflation– Increased lung volume– Flattened/inverted

diaphragm– Attenuated PVM– Retrosternal airspace

prominence• Bronchial wall

thickening

http://www.learningradiology.com/

BRONCHIECTASIS

Bronchiectasis

• Abnormal permanent dilatation of bronchi• Morpholigical groups– Cylindric– Varicose– Saccular/Cystic

Bronchiectasis

Cylindrical Saccular/Cystic

Bronchiectasis

• Kartagener Syndrome– Sinusitis– Situs Inversus– Bronchiectasis

Bronchiectasis

• Swyer-James syndrome– Postinfectious

bronchiectasis– Unilateral hemithorax

lucency– Adenovirus, measles,

pertussis

Bronchiectasis

• Allergic Bronchopulmonary Aspergillosis (ABPA)– Proximal, predominantly

upper lobe bronchiectasis

EMPHYSEMA

EmphysemaTYPE LOCATION

Centrilobular Central portion of the lobuleUpper lobes > Lower lobes

Spares distal portions

Panlobular Throughout the lobuleLower lobes > Upper lobes

Uniform distention

Paraseptal Peripheral airsacs adjacent to interlobular septaSubpleural regions of the upper lobes

Spares centrilobular regionCoalesce to form apical bullae

Paracicatricial/Irregular No consistent portion of the lobule

Destruction of lung tissue with fibrosisOld granulation inflammation

EmphysemaAterial Deficiency Emphysema Increased Markings Emphysema

Panlobular emphysema Centrilobular emphysema

Hyperinflated lungs Mild hyperinflation

Attenuated PVM Increasled linear parenchymal markings

Normal sized heart and central pulmonary vesselsBullae are common Bullae are uncommon

Pink puffers Blue bloaters

BULLOUS LUNG DISEASE

Bullae – thin-walled cystic spaces > 1cm in diameer within the lung parenchyma

Bullae

SMALL AIRWAYS DISEASEBronchioliis