- “In the last 10 years, on a total of 55 patients treated in our institution for benign lesions of the major airway, 20 were with an acute injury; eleven females and nine males with a mean age of 58 years (range of 24–92). Twelve lesions were iatrogenic (orotracheal intubation) and eight were post-traumatic (three blunt traumas, five penetrating traumas). The cervical trachea was involved in 13 cases (one associated to an incomplete esophageal transection and two associated to laryngeal injuries), the thoracic trachea in six cases (four extended to the right mainstem one and to the left).”
Acute major airway injuries: clinical features and management
Mussi A et al.
European j Cardio-Thoracic Surg
Vol 20, issue 1, July 2001; pages 46-52 - “Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy.”
Traumatic Injury to the Trachea and Bronchus
Karmy-Jones R, Wood DE
Thorac Surg Clin
2007 Feb; 17(1):35-46 - “Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The primary initial goals are twofold: stabilize the airway and define the extent and location of injury. These are often facilitated by flexible bronchoscopy, in the hands of a surgeon capable of managing these injuries. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy.”
Traumatic Injury to the Trachea and Bronchus
Karmy-Jones R, Wood DE
Thorac Surg Clin
2007 Feb; 17(1):35-46 - Churg Strauss Syndrome Dx made by vasculitis at biopsy and at least four of the following criteria
- Asthma
- Blood eosinophilia (>10% of total WBC count)
- Mono or polyneuropathy
- Nonfixed pulmonary infiltrates
- Sinus abnormality
- Extravascular eosinophils as seen on a bx specimen - Tracheobronchial Cartilage Calcification: Etiologies
- Idiopathic
- Congenital cardiovascular disease
- Keutel syndrome
- Chondroplasia punctata
- Warfarin embryopathy
- Warfarin sodium therapy - Tracheobronchial Calcification: Warfarin therapy
"As more CT examinations are performed on younger patients receiving warfarin, more cases of tracheobronchial calcification will be seen. Radiologists should realize that this finding is not normal in pediatric or young adult patients and should be aware of its association with warfarin sodium therapy."
CT Detection of Tracheobronchial Calcification in an 18-Year-Old on Maintenance Warfarin Sodium Therapy
Joshi A et al
AJR 2000;175:921-922 - Peripheral Pulmonary Stenosis: Differential Dx
- Newborns yet intervention rarely needed
- Rubella syndrome- tapering of pulmonary arteries from origin distally
- Noonan’s syndrome
- William’s syndrome
- Keutel syndrome - Dx: Keutel Syndrome
In 1972, Keutel [1] described a new malformative syndrome, characterized by diffuse and abnormal cartilage calcification, brachytelephalangism, hearing loss and pulmonary stenosis. - "Most tumors of the tracheobronchial tree are malignant. Benign tumors are quite rare (1.9% of all lung tumors). Unlike malignant tumors, many benign neoplasms are slow growing and present with symptoms related to bronchial obstruction."
Benign Tumors of the Tracheobronchial Tree: CT-Pathologic Correlation
Ko JM et al.
AJR 2006; 186:1304-1313 - Benign Tumors of the Tracheobronchial Tree: Differential Dx
- Hamartoma
- Leiomyoma
- Lipoma
- Neurogenic tumor
- Inflammatory polyp (fibroepithelial polyp)
- Amyloidoma
- Papilloma
- Pleomorphic adenoma - Benign Tumors of the Tracheobronchial Tree: Facts
- Up to 77% of benign tumors are hamartomas
- Post obstructive changes in the lung are common
- Hemoptysis common clinical presentation
- Leiomyoma usually arise in lower third of the trachea where there is more smooth muscle
- Lesions may have fat or calcification - Diffuse Narrowing of the Trachea or Main Bronchi
- Relapsing polychondritis
- Amyloidosis
- Sarcoidosis
- Wegener’s granulomatosis
- Tracheopathia osteochondroplastica
- Carcinoma
- Infection (TB, histoplasmosis, coccidiomycosis) - Non Neoplastic Lesions of the Trachea: Focal Disease
- Postintubation stenosis
- Postinfectious stenosis
- Posttransplantation stenosis
- Systemic diseases that involve the airway: Crohn's Disease, Sarcoidosis, and Behcet syndrome - Non Neoplastic Lesions of the Trachea: Diffuse Disease
- Wegener granulomatosis
- Relapsing polychondritis
- Tracheobronchopathia osteochondroplastica
- Amyloidosis
- Papillomatosis
- Rhinoscleroma - Tracheal Papillomatosis: Facts
- More common in children
- Occurs in 5% of patients with laryngeal papillomatosis
- May be single or multiple
- Airway obstruction may lead to atelectasis, air trapping, postobstructive infection or bronchiectasis - Tracheal Papillomatosis: Facts
- Drop lesions may cavitate
- Laser treatment common but lesions often recur
- Malignant degeneration to squammous cell carcinoma occurs in up to 10% of adult cases - Airway Stent Complications
- Malpositioning
- Migration
- Size discrepancy between airway and stent
- Excessive granulation tissue
- Stent fracture - "Computed tomography (CT) plays an important role in aiding planning of stent placement and in detecting various stent complications."
Multislice CT Evaluation of Airway Stents
Lee KS et al. J Thor imaging 2005;20:81-88
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