Diseases of the Trachea and Main-Stem Bronchi: Correlation of CT with Pathologic in in J. Stephen Nestor Roberta

This

article

most and

Kwong, L. Muller, R. Miller,

presents

common

CT

into

creased

focal

that

focal

abnormalities.

with

those

extent

uate

the

terms:

671.22,

671.622,

RadloGraphics I

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couver

the

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from

was

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Trachea,

#{149}#{149}

neoplasms.

decrease

performed

CT

671.22,

abnormal

tissues;

671.31.

671.68

Trachea,

671.32,

CT.

closely with for optilocation

the

walls;

#{149}

with

patients

necessary

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thin-

correlated

scans are demonstrates

671.458

it.

in 36 pa-

from

and

including

clas-

into

in patients CT

bronchial

671.1493,

that

incremental

of specimens

671.1493,

671.1492,

divided

performed

conventional

and

are

dynamic

characterize

tracheal

those was

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of Radiology

Uospital.

855 W 12th

30,

revision

to N.L.M.

and

bronchi

the

Bronchi

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#{149}Trachca. diseascs.

671.33

12:645-657

Departments January

a de-

Additional

helps

abnormalities,

671.68,

Received

to produce

diseases

analysis

abnormalities,

Trachea,

requests

tends

diffuse collimation

of the

#{149}

1992;

General

disease

extent of extraluminal disease, extension and lymphadenopathy.

Bronchi

671.33

are

but dynamic thin-section of focal abnormalities.

thickness

671.32,

main-stem abnormalities

10-mm

pathologic

of the

and

diameter

collimation)

features

The

airway

condition.

of disease;

termine the mediastinal

Focal

Findings

from

diffuse disease, mal assessment

Index

with

their

(CT)

trachea findings.

whereas

(1.5-5.0-mm

and

of the

the

CT

tomographic

pathologic diffuse.

increase

to assess

section

computed

diameter,

Conventional tients

and

and

airway

those

the

abnormalities

correlates

sified

MD MD, PhD MD

1992;

(J.S.K.,

N.L.M.)

Ave. Vancouver, requested March

and

Pathology

BC, Canada

6 and

received

(R.R.M.), V5Z

1M9.

March

University From

the

19; accepted

of British 1991

RSNA

March

Columbia scientific

20. Address

and

Van-

assembly.

reprint

1992

645

U INTRODUCTION A number of diseases may affect and main-stem bronchi. Patients any

symptoms

cific

or

symptoms

wheezing,

and

often

asthma

as cough, The

airway;

the

location

abnormalities;

associated

mediastinal

atelectasis, article

the

bronchi findings. or

All patients

be

and on

a broncho-

Saber-sheath trachea Tracheomalacia and Infectious disorders

diagnosis.

and

divided those

Focal

airway

with

with

bronchomalacia

focal

into that

main-stem those

that

cause

result

in diffuse

disease

tends

to produce

diameter.

The

diffuse

may

increase

that

be the

decrease

U FOCAL

further

divided

diameter

the

of the

diameter

into

those

airway

devices

RadioGraphics

U

Kwong

et al

that those

(Table).

DISEASES Stricture

Strictures of the trachea are usually damage from a cuffed endotracheal ostomy tube or trauma to the neck hypothesized that the cuff pressure

U

and

dis#{149} Tracheal

646

ulcer-

Additional

in patients trachea

and

(1,2).

polychondritis

Wegener granulomatosis Tracheopathia osteoplastica Tracheobronchitis associated ative colitis

contigu-

scanning.

diameter

Relapsing Amyloidosis Sarcoidosis

eases

disease

decreased

with

(Mounier-Kuhn

1.5-5.0-mm-collimation

of the may

disease

CT

is based

conventional

obtained

Diseases focal

Decreased

of

of the

proved

and

disease)

and the

article

in 36 patients

incremental

bronchi

trachea

pathologically

10-mm-collimation

scans were abnormalities.

presence

features

Trachea

neoplasms neoplasms

Tracheobronchomegaly

postobstruc-

correlates

underwent

dynamic

the

CT

The

of

of tracheo-

of the and

CT findings

ous

and

diseases

demon-

narrowing

extent

disease, pneumonitis.

pathologic scopically

and

and

main-stem

can or

reviews

common

the

(CT)

of the

Bronchi

Benign neoplasms Primary malignant Secondary malignant Diffuse diseases Increased diameter

is

of bron-

of widening

bronchial

most

course

misdiagnosis

tomography degree

This

dyspnea, clinical

of Diseases

Classification Main-Stem

Focal diseases Tracheal stricture

nonspe-

is common.

the

tive

with

such

and

Computed strate

present

stridor.

long-term,

chial

the

may

the trachea may not have

may

exceed

capillary

Volume

pressure,

12

caused by or trache(1). It is in these lead-

Number

4

a.

b.

FIgure 1. Tracheal stricture. (a) CT scan (1.5-mm months after extubation demonstrates narrowing immediately above this level demonstrates normal

collimation) of a patient of the tracheal lumen. (b) tracheal diameter.

ing

with stridor for 3 CT scan obtained

to ischemic

necrosis

and

subsequent

also

occur

brosis

(3).

Stricture

may

to the

cuff

at the

tracheostomy

CT scans rowing

in most that

missed

because

also ity

site.

can demonstrate

stenosis

cases.

the site of nar-

However,

involves

a short

ofvolume

of the

length

a web segment

averaging.

result in the overestimation of a fixed stenotic segment

estimation

fiproximal

and

of the

or may CT

be may

of the severthe under-

abnormal

tra-

chea (1 ,4) Better assessment of localized tracheal abnormalities can be achieved with contiguous 1.5-5.0-mm-collimation scans ob.

tamed

Figure

2. Squamous papilloma of the right mainstem bronchus. High-resolution (1 . 5-mm-collimation, high-spatial-frequency reconstruction algorithm) contrast material-enhanced CT scan obtained through the carina demonstrates an intraluminal polypoid mass in the right main-stem bronchus (arrow). The mass is well circumscribed, with no evidence of extension beyond the bronchial wall.

July

1992

through

the

area

breathhold

(Fig

#{149} Benign

Neoplasms

Benign neoplasms of tumors involving stem

bronchi

during

a single

1).

and

submucosal salivary mary mesenchymal

account for less than 10% the trachea and maininclude

papillomas

(Fig

gland tumors

adenomas, and such as hamarto-

Kwongetal

U

2),

pri-

RadioGraphics

U

647

Figure

3.

Hamartoma

of the left main-stem

chus. (a) CT scan (10-mm 1.5-cm partially calcified

collimation) lesion within

bron-

demonstrates the left main-

a

stem bronchus (arrows). Areas of decreased attenuation within the mass had CT numbers compatible with those of fat. These findings are suggestive of hamartoma. (b) Bouin-fi.xed gross pathologic specimen obtamed after a left lower lobectomy with sleeve resection of the left main-stem bronchus demonstrates endobronchial tumor fillingthe lumen with minimal extension into the wall. Scale is in centimeters. (c) Low-power photomicrograph (original magnification, X 25; hematoxylin-eosin stain) demonstrates fat and

cartilage

within

the

tumor. a.

mas (Fig 3). They scnibed, rounded, in diameter.

rowing, ing

all tend smooth,

As in other

stridor

is the

symptom

to be well circumand less than 2 cm cases

most

of tracheal

common

nan-

present-

(1,5-8).

of the

tracheal

mass,

cartilage.

nitively

diagnosed

strated

(Fig

which

is limited

Hamartomas at CT

if fat

the lo-

ing tions

can

be

648

U

RadioGrapbics

U

identify

demon-

establish dality.

Malignant

stridor,

The

lesions

radiographs

typically

but

Bronchoscopy of diagnosis and

the

Neoplasms

Primary malignant neoplasms of the trachea are uncommon, accounting for less than 1% of all thoracic malignancies (1,5,8). The presentation is variable, and the initial early symptoms are nonspecific, including dyspnea, wheezing,

asthma.

chest

be defi-

by

may

3).

#{149} Primary

chial

on

are

are

rarely

visible

identified

prospectively.

The CT scan will usually demonstrate polypoid configuration and intraluminal cation

As with other causes of tracheal narrowing, the patient may initially be treated for bron-

hemoptysis,

Kwong

et al

or dysphagia.

continues is highly

the

of the

mucosal

tumor.

the

to be the mainstay successful in helpand

intraluminal

It is difficult,

extent

Conversely,

of disease CT

por-

however,

enables

to

with

this

mo-

the

precise

evaluation of the extraluminal portion of the tumor, as well as the status of bronchi distal to tight stenoses. It is less useful in accurately distinguishing cosal

between

tumors.

underestimation the tumor. is therefore

CT

also

of the Bronchoscopy complementary

mucosal tends

longitudinal combined (5,9).

The

most

common

primary

nancies

are

squamous

cell

5) and

adenoid

cystic

and

to result

extent with

tracheal carcinoma

carcinoma

Volume

of CT

malig(Figs

(Fig

12

submuin the

4,

6).

Number

4

________

y

4. quamous c_I carcinoma at the level of the canina demonstrate of the tracheal lumen.

a.

_______

______

____________ Contrast-enhanceci

or t trachea. circumferential

thickening

of the

-

._..

,,..

tracheal

obtained

___

wall

with

irregular

narrowing

b. Figure 5. Squamous (a) Contrast-enhanced

carcinoma of the trachea. (10-mm collimation) obtained with the mediastinal settings through the trachea shows no abnormalities. (b) CT scan (10-mm collimation) with the lung settings shows a small, ill-

defined

region

cell

CT scan

of increased

attenuation

along

the

right side of the trachea. (c) High-resolution (1 . 5-mm collimation, high-spatial-frequency reconstruction algorithm) contrast-enhanced CT scan obtained through the same region clearly demonstrates a small enhanced nodule arising from the right tracheal wall, with no evidence of extraluminal extension. Additional 1.5-mm-collimation CT scans were obtained because a small focal tracheal abnormality was seen at bronchoscopy.

C.

July

1992

Kwong

et al

U

RadioGrapbics

U

649

a.

b.

Figure

6.

Adenoid

tamed through chea. Note the tinuous tracheal major infiltrating

cystic

the trachea intraluminal rings show component.

carcinoma

of the trachea.

(a) Contrast-enhanced

demonstrates a mass producing extension of the tumor (arrow). tumor of the left cartilaginous Scale is in centimeters.

CT scan

(3-mm

collimation)

oh-

irregular thickening of the left wall of the ti-a(b) Bouin-fixed gross specimens of two disconwall with a minor exophytic component and a

.

.p’.

.).

,,.

-

L

..

1?.

#{248}bL

a.

b.

Figure

7. Mucoepidermoid carcinoma of the trachea. (a) Contrast-enhanced CT scan (5-mm collimation) demonstrates irregular thickening of the left posterolateral tracheal wall with nodular intraluminal extension of tumor (arrow). No extension beyond the airway is seen. (b) Low-power photomicrograph (original magnification, x 2; periodic acid-Schiff stain with diastase) of a tracheal ring open before fixation shows an exophytic mucoepidermoid tumor primarily involving the membranous trachea.

Less

common

moid

(Fig

(1,5,8,10).

tumors include mucoepidercarcinoid (Fig 8) tumors Other tumors are rare (Fig 9). Be-

7) and

cause of the vascular nature of carcinoid tumors, they may show marked enhancement on CT scans obtained after intravenous administration of contrast material (Fig 7) (9,11).

650

U

RadioGraphics

U

Kwong

et al

#{149} Secondary The trachea

Malignant

Neoplasms

and

main-stem bronchi may be involved with malignancies arising elsewhere, either through direct invasion or, less cornmonly, through hematogenous metastasis to the mucosa. The most common malignancies that locally invade the trachea include cancers of the thyroid, esophagus, larynx, and lung. Hematogenous metastases are rare. The most common sources for hematogenous me-

Volume

12

Number

4

FigureS. Carcinoid tumor of the trachea. scan (S-mm collimation) obtained through chea demonstrates a well-defined, rounded minal mass arising from the left posterolateral

(a) CT the traintraluwall

of the trachea. No obvious extension of tumor beyond the airway is seen. (b) After an injection of contrast material, the mass enhances dramatically with no evidence of extension. (c) Nonfixed gross specimen demonstrates tumor of the left lateral

a polypoid erythematous tracheal wall.

a.

b.

C.

FIgure

9.

Giant

cell

carcinoma

of the

trachea.

Contrast-enhanced CT scan (5-mm collimation) obtained just above the carina demonstrates a polypoid mass extending from the right tracheal wall into the tracheal lumen (arrow). Circumferetitial thickening of the tracheal wall is present, with no gross evidence of invasion of other mediastinal structures.

July

1992

Kwong

et al

U

RadioGrapbics

U

651

Figure 10. Metastatic melanoma Contrast-enhanced CT scan (5-mm

of the trachea. collimation) demonstrates a well-defined, rounded intraluminal mass arising from the right posterolateral wall. No tracheal thickening or extraluminal extension is seen.

Figure

11.

main-stem

Tracheobronchomegaly. bronchi

chea measured respectively.

tastases

demonstrate 3.3

are

CT scans diffuse

cm in diameter,

melanomas

(Fig

and

10),

(1.5-mm

dilatation the

breast

right

carci-

nomas, and malignancies of the genitourinary tract. On CT scans, the lesions usually appear as a polypoid soft-tissue mass that is generally solitary but may be multiple (1,12).

collimation)

of the and

left

trachea main-stem

The and

DISEASE INCREASED

THAT PRODIAMETER

Tracheobronchomegaly (Mounier-Kuhn ease) is a rare condition characterized marked dilatation of the trachea and

652

U

RadioGrapbic.s

U

Kwong

et al

disby bronchi.

both

through

main-stem

bronchi

the trachea bronchi.

measured

3.0

disease affects primarily 5th decades. The cause

ically,

the

or may

patient

present

infections tions

DIFFUSE DUCES AN

U

obtained and

may

may

with

not

bronchitis.

lead

to bronchiectasis

and

tra-

3.4

cm,

men in their is unknown. have

repeated

and

and

The

any

4th Clin-

symptoms

respiratory Recurrent

tract infec-

(1,2).

The CT scan demonstrates enlargement the central airways (Fig 1 1). In adults, the by a diameter

of di-

agnosis

is established

trachea ameter greater Tracheal ducing appearance

that is greater than 3.0 cm or by a diof the right or left main-stem bronchi than 2.4 or 2.3 cm, respectively (13). diverticulosis may be present, proan irregular corrugated or scalloped of the trachea (1,14).

Volume

12

of the

Number

4

Figure

12. Relapsing polychondritis. (a) Contrastenhanced CT scan (1.5-mm collimation) obtained through the trachea demonstrates mild circumferential thickening of the tracheal wail (arrow) with slight narrowing of the airway diameter. (b) CT scan obtained at the level of the main-stem bronchi shows more easily the narrowing of the airway diameter (arrows). (Reprinted, with permission, from reference 15.) (c) Low-power photomicrograph (original magnification, x 2 5 ; hematoxylin-eosin stain) of tracheal biopsy specimen shows a chronic inflammatory infiltrate destroying the inner (straight arrows) and outer (curved arrows) perichondrium.

with C.

episodic

airways,

mities

are

Pathologically,

the the

cartilaginous

Because of the underlying of the tracheal wall, portions of the and submucosa may bulge outward the tracheal rings, producing the diverticulosis seen on CT scans (2).

mucosa between tracheal

DIFFUSE PRODUCE

#{149} Relapsing Relapsing

polychondritis

in which

cartilage

current

also ease tive

July

Polychondritis

episodes laryngeal, include

1992

disorder.

The cartilages

The

polyarthritis,

is classified

diffusely

tracheal

involved.

structures, tissue

is affected

of inflammation.

findings

as an

arteritis

(2).

autoimmune

Patients

ofthe

present

wall

gressing

(16).

flaccid,

likely

representing

malacia

(1).

Pathologically,

tory

exudate

(Fig

12).

The

and

structure. mentation

Progressive and eventual

are

brous

Gross pro-

stenosis

may

of tracheo-

a dense

inflamma-

perichondrium and Cartilage

properties

traloses

and

dissolution replacement

follow

may

become

submucosa,

pinnal,

may

(1,15). rings

normal.

by

Ira-

thicken-

a form

mucosa, appear

staining

tissue

12)

the

basophilic

i-c-

of the

trachea

surrounds

glands

are

associated

(Fig

the

defor-

(2,3).

narrowing

fibrosis

Rarely,

ears,

nose

airways

cartilaginous

to cicatricial

occur

major

is noted

of the

nose,

and

50% of cases, and is the most common

with

disease

its

lacunar and

fragby fi-

(15).

may

inflammation

and

lumen

destruction

Ear

patients

a fixed

cheobronchial ing

than

in these

CT scans,

cheal

is a systemic

and

commonly

ofdeath

On

of the

joints. The

in greater pneumonia

cause

tissues

DISEASES THAT A DECREASED DIAMETER

U

ocular

elastic

atrophied.

weakness

nasal,

and

are

are

most

muscular

rings

and

and

common.

involved recurrent dilated,

inflammation

upper

of

The

dis-

connecclinically

Kwong

et al

U

RadioGrapbics

U

653

13 Figures

14. 13,

14. (13) Amyloidosis. Contrast-enhanced CT scan (10-mm collimation) of the main bronchi demonstrates considerable narrowing of the left main-stem bronchus produced by an eccentric nodular mass along its posterolateral wall (arrow). (14) Tracheopathia osteoplastica. Contrast-enhanced CT scan (S-mm collimation) demonstrates irregular thickening of the tracheal cartilages. Multiple calcified nodular tumors extend into the lumen from the lateral walls (arrows). No involvement of the posterior wall is seen.

#{149} Amyloidosis

strated

Amyloidosis

is a condition

in which

a fibrillar

protein is deposited in various organ systems. The lungs and central airways may be involved in systemic disease or may be the only organ involved (2) Tracheobronchial involvement in amyloidosis localized to the respiratory tract most commonly takes the form of .

diffuse

or

multifocal

(1,2,15). mucosal

submucosal

Less commonly, masslike lesion.

cosa

is usually

tion

may

intact.

infiltrates

there is a single subThe overlying mu-

Calcification

or ossifica-

occur.

On CT scans, with

a thickened

may

be

wall

seen.

be focal

the lumen The

appears

(Fig

13).

distribution

or diffuse

narrowed,

Calcification of lesions

may

(1,2).

(9).

sarcoidosis

Pathologically,

the

is the

of noncaseating

presence

hallmark

of

granulomas.

#{149} Wegener

Granulomatosis

Wegener

granulomatosis

vasculitis

with

is characterized

granulomatous

by a

inflammation

primarily involving the lungs, kidneys, and upper and lower respiratory tract. Involvement of the trachea is uncommon and is typically a late manifestation. Rarely, tracheal stenosis

may

be

the

initial

abnormality

On CT scans, the major airways rowed with abnormal soft tissue laryngeal cartilages and tracheal logically, mucosal or submucosal tous inflammation and vasculitis

(17).

are nanwithin the rings. Pathogranulomaare present

(9,17).

#{149} Sarcoidosis The in

larynx

and

1%-3%

subglottic

of patients

trachea with

ease is usually present elsewhere, rarely the proximal airway may site

(2).

Sarcoidosis

granulomatous main-stem compression mediastinal tinal

fibrosis. of extrinsic

thickening

may

CT

of their

disease

affected Dis-

although be the initial

produce

intrinsic

can

help

masses extent.

involves

the

enable

In cases

in which

tracheal

submucosa,

the

of the

confirm and

tracheal

wall

may

#{149} Tracheopathia

presan

estimathe

condition

osteoplastica involving

bronchi

with

the

formation

osteocartilaginous

is a rare trachea

and

of multiple growths

benign major

submuwithin

the

anterior and lateral walls. The posterior walls are spared, as they contain no cartilage. The cause is unknown (2,18). On CT scans, the tracheal cartilages are thickened with irregular calcification (Fig 14). Multiple nodules with or without calcification may

the be demon-

Osteoplastica

Tracheopathia

cosal

lesions of the trachea and bronchi or may cause extrinsic of these airways due to enlarged lymph nodes or extensive medias-

ence tion

are

sarcoidosis.

ered

be

seen

anterior to be

protruding

and

lateral

into

the

walls.

pathognomonic

for

lumen

from

This

is consid-

this

condition.

Typically, a long segment of the trachea is involved with possible extension to the mainstem bronchi (1,2,18).

654

U

RadioGraphics

U

Kwong

et al

Volume

12

Number

4

a.

d.

b. Figure

C.

15. Tracheobronchitis associated with ulcerative colitis. (a) CT scan (5-mm collimation) obtained at the level of the trachea demonstrates circumferential thickening of the tracheal wall, with no extension beyond the cartilage (arrow). (b, c) CT scans obtained at the level of the canina show diffuse circumferential thickening

of the

(c). (Reprinted, tnichrome submucosal

bronchial

walls

with permission,

stain) of the trachea fibrosis (arrows).

Pathologically,

the

(arrow) (b), with considerable narrowing of the left bronchial lumen from reference 19.) (d) Pathologic specimen (original magnification, x 2; demonstrates circumferential submucosal sclerosing tracheitis and highlights

masses

are

composed

of

chiolitis

elements.

though

The

connection

mucosal

to the

dent,

suggesting

native

cartilage

surface

perichondnium

that

the lesions

arise

from

(2).

#{149} Tracheobronchitis Ulcerative

Associated

with

way

disease

July

1992

abnormalities

range with

has

to that

from

of the

predominantly

tracheobronchitis

noted

On CT scans,

pattern

of sclerosing

no association

been

disease The

with

bron-

of disease

cholangitis,

with

this

is al-

abnormality

(19).

the tracheobronchial

thickened, producing 15). Bronchiectasis Pathologically, the fibrosis

walls

are

irregular narrowing may be demonstrated. airway lumen is narrowed

(Fig

of the

submucosa.

The

of ulcerative

manifestations

include

Changes

similar

to small-airway obliterans.

by concentric

Colitis

Extraintestinal

colitis

with marrow is intact. A is often cvi-

chiectasis

submucosal islands of hyaline cartilage areas of lamellar bone and occasional

airways.

large-airor hi-on-

Kwong

et al

U

RadioGraphics

U

655

Figure

16.

CT scan

Tracheomalacia.

(5-mm

Contrast-enhanced

collimation)

shows

marked

narrow-

ing of the trachea adjacent to an aortic aneurysm. No thickening of the tracheal wall is demonstrated. At bronchoscopy, the trachea collapsed on expiration.

mucosa is inflamed and ulcerated. Both the membranous and cartilaginous portions are involved. The cartilaginous plates may be calcified

but

are

not

destroyed

#{149} Saber-Sheath

Trachea

The

sagittal diameter mally slightly greater

ter. Occasionally, markedly reduced, configuration with

chronic

and

almost

(1,2).

chea

changes

abnormal

occurs from

calcification

pa-

of the the

is common.

in children

at

U

RadioGrapbics

U

Kwong

et al

airway

disease,

or polychondritis.

older

and

breath

and

present

refer to a and censtruc-

flaccidity

and

airways during forced form of the disease may

in whom

the cartilage

bronchomalacia

to intubation,

tions,

trauma,

may

chronic

obstruc-

recurrent

infec-

These

clinically

is

patients

with

are

shortness

of

At bronchoscopy, excessive collapsibility of the airways during a volunt#{227}rycough is noted (3). On CT scans, tracheomalacia is considered to be present if the trachea collapses more than 50% on expiration (Fig 16). Use of ultrafast

656

to increased

be found

tive ira-

intratho-

portion, abruptly narrows.

leads

of the major A primary

be secondary

disease

in male

This

collapse expiration.

congenitally deficient. Tracheomalacia and

associated

configuration

to the extrathoracic the coronal diameter the sagittal diameter

ring

is

pulmonary

as it moves

racic portion which point widens and

diameter

in a saber-sheath

It is commonly

exclusively

The

Tracheal

the coronal resulting

and

Tracheomalacia and bronchomalacia weakness of the walls of the trachea tral bronchi, as well as their supporting tunes.

of the trachea is northan the coronal diame-

obstructive

tients.

(19).

#{149} Tracheomalacia Bronchomalacia

CT

wheezing.

facilitates

examining

Volume

the

patient

12

dur-

Number

4

ing

expiration,

study

the

and

that

may

trachea

static

caliber,

images

bronchitis

ing

may

of

be missed

on 8.

are

be involved

disease

most viral

in viral,

processes.

cases

9.

In

of laryngotracheo-

in nature

(parainfluenza

or

is common,

but

tracheal

branous

form

radiographically

narrowing of croup

demon-

is unusual. exists

that

A mem-

may

disorders

1 1.

cause

proximal tracheal irregularity. CT scans are rarely obtained for the assessment of these

U

10.

syncytial viruses most commonly). cases, subglottic or laryngeal narrow-

strable

12.

(2,15).

SUMMARY

CT is a valuable focal

and

main-stem

location

of the

in the investigation

diseases

bronchi.

and

ize abnormal ness

tool

diffuse extent

CT

tracheal

of the can

demonstrate

help

help wall;

evaluate and

of

trachea

ofdisease;

tissues;

help

abnormalities findings.

correlate

13.

and the

character-

14.

the thickdetermine

the extent of extraluminal disease, including the presence of mediastinal extension and lymphadenopathy. CT findings in both focal and diffuse the pathologic

well

with

15.

16.

REFERENCES

U 1.

2.

3.

4.

5.

6.

July

Gamsu G, Webb WR. Computed tomography of the trachea and mainstem bronchi. Semin Roentgenol 1983; 18:51-59. Choplin RH, Wehunt WD, Theros EG. Diffuse lesions of the trachea. Semin Roentgenol 1983; 18:38-50. Fraser RG, Pare JAP, Pare PD, Fraser RS, Genereux GP, eds. Diagnosis ofdiseases of the chest. Vol 3. Philadelphia: Saunders, 1990; 1987-2003. Gamsu G, Webb WR. Computed tomography of the trachea: normal and abnormal. AiR 1982; 139:321-326. Naidich DP. CT/MR correlation in the evaluation of tracheobronchial neoplasia. Radiol Clin North Am 1990; 28:SSS-57 1. Swain ME, Coblentz CL. Tracheal chondroma: CT appearance. J Comput Assist Tomogr 1988; 12:1085-1086.

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Allen AJ, Angell F, HankinsJ, Whitley Leiomyoma ofthe trachea. AJR 1983; 683-684. Felson B. Neoplasms of the trachea mainstem bronchi. Semin Roentgenol

NO. 141: and 1983;

18: 23-37.

may

fungal

America,

respiratory In these

7.

a dynamic

abnormalities

which

airways or

North

allows

Disorders

major

bacterial,

CT

identify

(3,20).

#{149} Infectious The

cine

help

17.

18.

19.

20.

ShepardJO,

McLoud TC. Imaging the airways: computed tomography and magnetic resonance imaging. Clin Chest Med 1991; 12: 15 1-168. Weber AL, Grillo HC. Tracheal tumors: a radiological, clinical, and pathological evaluation of84 cases. Radiol Clin North Am 1978; 16: 227-246. Forster BB, Muller NL, Miller RR, Nelems B, Evans KG. Neuroendocnine carcinomas of the lung: clinical, radiologic, and pathologic correlation. Radiology 1989; 170:441-445. Spizarny DL, ShepardJO, McLoud TC, Grillo HC, Dedrick CJ. CT ofadenoid cystic carcinoma ofthe trachea. AJR 1986; 146:11291132. Shin MS, Jackson RM, Ho KJ. Tracheobronchomegaly (Mounier Kuhn syndrome): CT diagnosis. AiR 1988; 150:770-779. Dunne MG, Reiner B. CT features of tracheobronchomegaly. J Comput Assist Tomogr 1988; 12:388-391. MUller NL, Miller RR, Ostrow DN, Pare PD. Clinico-radiologic-pathologic conference: diffuse thickening of the tracheal wall. Can Assoc RadiolJ 1989; 40:213-21S. ImJG, ChungJW, Han 5K, Han MC, Kim CW. CT manifestations of tracheobronchial involvement in relapsing polychondritis. J Cornput Assist Tomogr 1988; 12:792-793. Stin MG, Gamsu G, Webb WR, Stulbarg MS. Computed tomography of diffuse tracheal stenosis in Wegener granulomatosis. J Comput Assist Tomogr 1986; 10:868-870. Onitsuka H, Hirose N, Watanbe K, et al. Computed tomography of tracheopathia osteoplastica. AiR 1983; 140:268-270. Wilcox P, Miller R, Miller G, et al. Airway involvement in ulcerative colitis. Chest 1987; 92:18-22. Ell SR,Jolles H, GalvinJR. Cine CT demon. stration of nonfixed upper airway obstruction. AJR 1986; 146:669-677.

Kwong

et al

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RadioGrapbic.s

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