From the Guidelines
The next steps for tracheomegaly noted on CT should include a pulmonary consultation and additional diagnostic testing to determine the cause and severity, as recommended by the most recent guidelines 1.
Diagnostic Testing
A complete pulmonary function test should be ordered, including spirometry with flow-volume loops to assess for airway obstruction. High-resolution CT imaging of the chest may be needed if not already performed, with specific measurements of the tracheal diameter, as suggested by the American College of Radiology 1.
- Bronchoscopy may be necessary to directly visualize the trachea and collect samples if infection is suspected.
- Laboratory tests should include alpha-1 antitrypsin levels, inflammatory markers, and tests for connective tissue disorders if clinically indicated.
Management
Management depends on the underlying cause, with treatment focusing on addressing any identified etiology such as infections, inflammatory conditions, or congenital disorders.
- For symptomatic patients with recurrent infections, chest physiotherapy and airway clearance techniques may be recommended, as suggested by the British Thoracic Society guideline for bronchiectasis in adults 1.
- Tracheomegaly is often associated with conditions like Mounier-Kuhn syndrome, chronic infections, or connective tissue disorders, so identifying the underlying cause is crucial for appropriate management, as noted in the study on uncommon causes of cough 1.
Follow-up
Regular follow-up with pulmonology is important to monitor disease progression and adjust treatment as needed, with consideration of therapeutic bronchoscopy and other interventions as recommended by the American College of Chest Physicians clinical practice guideline 1.
From the Research
Next Steps for Tracheomegaly
The next steps for a patient with tracheomegaly noted on computed tomography (CT) scan may include:
- Further evaluation with chest radiography to exclude a large airway 2
- Chest computed tomography and fiber-optic bronchoscopy to provide a diagnosis of a large airway 2
- Pulmonary function tests (PFT) to assess underlying small airway disorders, although PFT results may be normal in patients with large airway disorders 3
- Consideration of airway management strategies, including tracheal re-intubation and tracheal repair, in patients with acquired tracheomegaly 4
- Use of a longer tracheostomy tube or modification of the endotracheal tube to manage peri-cuff air leak and hypercapnea in patients with tracheomegaly 5
Diagnostic Features
The CT features of tracheobronchomegaly include:
- Dilatation of the trachea and mainstem bronchi
- Tracheal diverticulosis
- Bronchiectasis
- Chronic pulmonary parenchymal disease 6
- Collapse of the trachea and large diverticular out-pouching and openings in the trachea, as seen in bronchoscopy 3
Management Considerations
Management of tracheomegaly may involve: