Nonneoplastic Lesions of the Tracheobronchial Wall: Radiologic Findings with Bronchoscopic Correlation1
Jeffrey S. Prince, MD,
David R. Duhamel, MD,
David L. Levin, MD, PhD,
James H. Harrell, MD and
Paul J. Friedman, MD
1 From the Department of Radiology (J.S.P., D.L.L., P.J.F.) and the Pulmonary Special Procedures Unit (D.R.D., J.H.H.), Division of Pulmonary and Critical Care Medicine, UCSD Medical Center, 200 W Arbor Dr, Mail Code 8756, San Diego, CA 92103-8756. Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received February 2, 2002; revision requested March 20 and received April 11; accepted April 18. Address correspondence to D.L.L. (e-mail: dlevin@ucsd.edu).
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Figure 1a. Postintubation stenosis. (a, b) Conventional radiographs obtained in a 42-year-old man (a) and a 70-year-old woman (b) demonstrate focal subglottic stenosis (arrow) that resulted from prolonged intubation. (c) Corresponding bronchoscopic image obtained in the same patient as in b shows marked subglottic narrowing.
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Figure 1b. Postintubation stenosis. (a, b) Conventional radiographs obtained in a 42-year-old man (a) and a 70-year-old woman (b) demonstrate focal subglottic stenosis (arrow) that resulted from prolonged intubation. (c) Corresponding bronchoscopic image obtained in the same patient as in b shows marked subglottic narrowing.
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Figure 1c. Postintubation stenosis. (a, b) Conventional radiographs obtained in a 42-year-old man (a) and a 70-year-old woman (b) demonstrate focal subglottic stenosis (arrow) that resulted from prolonged intubation. (c) Corresponding bronchoscopic image obtained in the same patient as in b shows marked subglottic narrowing.
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Figure 2a. Posttuberculous stenosis in a 24-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a focal stricture (arrow) at the proximal left main bronchus beginning just distal to the carina. The remainder of the bronchus is also narrowed and irregular. Volume has been lost from the left lower lobe. (c) Bronchoscopic image also shows the focal stenosis (arrow).
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Figure 2b. Posttuberculous stenosis in a 24-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a focal stricture (arrow) at the proximal left main bronchus beginning just distal to the carina. The remainder of the bronchus is also narrowed and irregular. Volume has been lost from the left lower lobe. (c) Bronchoscopic image also shows the focal stenosis (arrow).
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Figure 2c. Posttuberculous stenosis in a 24-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a focal stricture (arrow) at the proximal left main bronchus beginning just distal to the carina. The remainder of the bronchus is also narrowed and irregular. Volume has been lost from the left lower lobe. (c) Bronchoscopic image also shows the focal stenosis (arrow).
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Figure 3a. Postinflammatory stenosis due to Coccidioides infection in a 35-year-old man. (a) Conventional radiograph shows a long segment of narrowing that involves the left main bronchus (arrowheads). (b) Bronchoscopic image shows a stricture at the origin of the left main bronchus (arrow).
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Figure 3b. Postinflammatory stenosis due to Coccidioides infection in a 35-year-old man. (a) Conventional radiograph shows a long segment of narrowing that involves the left main bronchus (arrowheads). (b) Bronchoscopic image shows a stricture at the origin of the left main bronchus (arrow).
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Figure 4a. Posttransplantation stenosis in a 45-year-old woman who had undergone bilateral lung transplantation. (a) CT scan shows a focal stenosis at the anastomotic site within the right lung. (b) Bronchoscopic image shows granulation tissue and narrowing as well as suture material (arrowheads).
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Figure 4b. Posttransplantation stenosis in a 45-year-old woman who had undergone bilateral lung transplantation. (a) CT scan shows a focal stenosis at the anastomotic site within the right lung. (b) Bronchoscopic image shows granulation tissue and narrowing as well as suture material (arrowheads).
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Figure 5a. Crohn disease in a 39-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a long segment of irregular narrowing (arrow) that primarily involves the proximal left main bronchus. (c) Bronchoscopic image shows mucosal edema and granulation tissue with endobronchial obstruction.
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Figure 5b. Crohn disease in a 39-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a long segment of irregular narrowing (arrow) that primarily involves the proximal left main bronchus. (c) Bronchoscopic image shows mucosal edema and granulation tissue with endobronchial obstruction.
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Figure 5c. Crohn disease in a 39-year-old woman. (a, b) Conventional radiograph (a) and CT scan (b) show a long segment of irregular narrowing (arrow) that primarily involves the proximal left main bronchus. (c) Bronchoscopic image shows mucosal edema and granulation tissue with endobronchial obstruction.
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Figure 6a. Sarcoidosis in a 37-year-old man. (a) CT scan shows marked narrowing of the bronchus intermedius (arrow) by an adjacent nodal mass. Densely calcified nodes are seen within the right hilum (arrowhead). (b) Bronchoscopic image shows mucosal inflammation in addition to focal stenosis.
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Figure 6b. Sarcoidosis in a 37-year-old man. (a) CT scan shows marked narrowing of the bronchus intermedius (arrow) by an adjacent nodal mass. Densely calcified nodes are seen within the right hilum (arrowhead). (b) Bronchoscopic image shows mucosal inflammation in addition to focal stenosis.
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Figure 7a. Behçet syndrome in a 36-year-old man. (a) Conventional radiograph shows a long segment of stenosis within the left main bronchus (arrowheads) that begins just distal to the carina. Volume loss within the left lung is significant. (b) Bronchoscopic image shows stenosis of the left main bronchus (arrow).
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Figure 7b. Behçet syndrome in a 36-year-old man. (a) Conventional radiograph shows a long segment of stenosis within the left main bronchus (arrowheads) that begins just distal to the carina. Volume loss within the left lung is significant. (b) Bronchoscopic image shows stenosis of the left main bronchus (arrow).
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Figure 8a. Wegener granulomatosis. (a) Chest radiograph obtained in a 27-year-old woman shows a long segment of narrowing that extends from the subglottic space to the thoracic inlet. (b) CT scan obtained in a 55-year-old woman shows circumferential thickening of the tracheal mucosa. (c) Bronchoscopic image obtained in the same patient as in a shows subglottic stenosis and irregular mucosal thickening.
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Figure 8b. Wegener granulomatosis. (a) Chest radiograph obtained in a 27-year-old woman shows a long segment of narrowing that extends from the subglottic space to the thoracic inlet. (b) CT scan obtained in a 55-year-old woman shows circumferential thickening of the tracheal mucosa. (c) Bronchoscopic image obtained in the same patient as in a shows subglottic stenosis and irregular mucosal thickening.
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Figure 8c. Wegener granulomatosis. (a) Chest radiograph obtained in a 27-year-old woman shows a long segment of narrowing that extends from the subglottic space to the thoracic inlet. (b) CT scan obtained in a 55-year-old woman shows circumferential thickening of the tracheal mucosa. (c) Bronchoscopic image obtained in the same patient as in a shows subglottic stenosis and irregular mucosal thickening.
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Figure 9a. Relapsing polychondritis. (a) Conventional radiograph obtained in a 75-year-old woman shows a long segment of tracheal narrowing and irregularity. (b) End-inspiration and end-expiration CT scans obtained in a 64-year-old man show dynamic collapse of the trachea with expiration (right). Calcification and thickening of the cartilaginous portions of the trachea (arrow) with sparing of the posterior wall (arrowhead) are also seen. (c) Bronchoscopic image obtained in the same patient as in a shows diffuse mucosal edema with dynamic airway collapse.
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Figure 9b. Relapsing polychondritis. (a) Conventional radiograph obtained in a 75-year-old woman shows a long segment of tracheal narrowing and irregularity. (b) End-inspiration and end-expiration CT scans obtained in a 64-year-old man show dynamic collapse of the trachea with expiration (right). Calcification and thickening of the cartilaginous portions of the trachea (arrow) with sparing of the posterior wall (arrowhead) are also seen. (c) Bronchoscopic image obtained in the same patient as in a shows diffuse mucosal edema with dynamic airway collapse.
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Figure 9c. Relapsing polychondritis. (a) Conventional radiograph obtained in a 75-year-old woman shows a long segment of tracheal narrowing and irregularity. (b) End-inspiration and end-expiration CT scans obtained in a 64-year-old man show dynamic collapse of the trachea with expiration (right). Calcification and thickening of the cartilaginous portions of the trachea (arrow) with sparing of the posterior wall (arrowhead) are also seen. (c) Bronchoscopic image obtained in the same patient as in a shows diffuse mucosal edema with dynamic airway collapse.
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Figure 10a. Tracheobronchopathia osteochondroplastica in a 36-year-old woman. (a) Conventional radiograph shows irregularity and narrowing over a long segment of the trachea. (b) CT scan of the middle part of the trachea shows irregular narrowing of the airway with calcification of the lateral walls. (c) Bronchoscopic image shows multiple osteocartilaginous nodules.
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Figure 10b. Tracheobronchopathia osteochondroplastica in a 36-year-old woman. (a) Conventional radiograph shows irregularity and narrowing over a long segment of the trachea. (b) CT scan of the middle part of the trachea shows irregular narrowing of the airway with calcification of the lateral walls. (c) Bronchoscopic image shows multiple osteocartilaginous nodules.
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Figure 10c. Tracheobronchopathia osteochondroplastica in a 36-year-old woman. (a) Conventional radiograph shows irregularity and narrowing over a long segment of the trachea. (b) CT scan of the middle part of the trachea shows irregular narrowing of the airway with calcification of the lateral walls. (c) Bronchoscopic image shows multiple osteocartilaginous nodules.
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Figure 11a. Tracheobronchial amyloidosis in a 51-year-old woman. (a) Conventional radiograph shows irregular narrowing of the trachea over a long segment. (b) CT scan shows mucosal thickening with irregular calcification that involves the posterior membrane. (c) Bronchoscopic image shows diffuse nodular deposits that involve all portions of the trachea.
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Figure 11b. Tracheobronchial amyloidosis in a 51-year-old woman. (a) Conventional radiograph shows irregular narrowing of the trachea over a long segment. (b) CT scan shows mucosal thickening with irregular calcification that involves the posterior membrane. (c) Bronchoscopic image shows diffuse nodular deposits that involve all portions of the trachea.
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Figure 11c. Tracheobronchial amyloidosis in a 51-year-old woman. (a) Conventional radiograph shows irregular narrowing of the trachea over a long segment. (b) CT scan shows mucosal thickening with irregular calcification that involves the posterior membrane. (c) Bronchoscopic image shows diffuse nodular deposits that involve all portions of the trachea.
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Figure 12a. Papillomatosis. (a) Conventional radiograph obtained in a 31-year-old man shows irregular narrowing throughout the trachea. (b) CT scan obtained in a 30-year-old man shows multiple nodules that project into the tracheal lumen. Multiple parenchymal papillomas are also present. (c) Bronchoscopic image obtained in the same patient as in b shows multiple polypoid lesions within the trachea.
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Figure 12b. Papillomatosis. (a) Conventional radiograph obtained in a 31-year-old man shows irregular narrowing throughout the trachea. (b) CT scan obtained in a 30-year-old man shows multiple nodules that project into the tracheal lumen. Multiple parenchymal papillomas are also present. (c) Bronchoscopic image obtained in the same patient as in b shows multiple polypoid lesions within the trachea.
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Figure 12c. Papillomatosis. (a) Conventional radiograph obtained in a 31-year-old man shows irregular narrowing throughout the trachea. (b) CT scan obtained in a 30-year-old man shows multiple nodules that project into the tracheal lumen. Multiple parenchymal papillomas are also present. (c) Bronchoscopic image obtained in the same patient as in b shows multiple polypoid lesions within the trachea.
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Figure 13a. Rhinoscleroma. (a) CT scan obtained in a 19-year-old woman shows circumferential thickening of the trachea. (b) Bronchoscopic image obtained in a 33-year-old woman shows multiple white-green plaques and mucosal edema.
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Figure 13b. Rhinoscleroma. (a) CT scan obtained in a 19-year-old woman shows circumferential thickening of the trachea. (b) Bronchoscopic image obtained in a 33-year-old woman shows multiple white-green plaques and mucosal edema.
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Copyright © 2002 by the Radiological Society of North America.
