From the Guidelines
The saber-sheath configuration of the trachea with trace endotracheal secretions should be managed with standard treatment protocols for the underlying condition, prioritizing symptoms such as chronic cough and dyspnea, and considering tracheobronchial stenting or surgical treatment with tracheoplasty or tracheobronchoplasty if symptomatic expiratory central airway collapse (ECAC) is confirmed 1.
The saber-sheath configuration of the trachea is a radiographic finding that can be associated with various conditions, including tracheomalacia and expiratory central airway collapse (ECAC) 1. ECAC is characterized by excessive narrowing of the trachea, central bronchi, or both at expiration, and can cause symptoms such as chronic cough and dyspnea 1. The presence of trace endotracheal secretions may indicate an underlying condition such as bronchiectasis, which is defined as irreversible abnormal bronchial dilatation, and can be associated with chronic productive cough and impaired bronchial clearance and airway immune mechanisms 1.
Key considerations in managing the saber-sheath configuration of the trachea with trace endotracheal secretions include:
- Evaluating for underlying conditions such as ECAC, tracheomalacia, or bronchiectasis 1
- Assessing symptoms such as chronic cough and dyspnea, and monitoring for potential airway complications 1
- Considering treatment options such as tracheobronchial stenting, surgical treatment with tracheoplasty or tracheobronchoplasty, or preventive airway clearance therapies, anti-inflammatory agents, prophylactic or therapeutic antibiotics, and, in severe cases, surgical resection or lung transplantation 1
- Providing supportive care, including adequate hydration and humidified oxygen if needed, to help manage symptoms and prevent complications 1
It is essential to prioritize the management of symptoms and underlying conditions, rather than the saber-sheath configuration itself, to improve patient outcomes and quality of life 1.
From the Research
Saber-Sheath Trachea Configuration
- The saber-sheath trachea configuration is characterized by narrowing of the intrathoracic trachea in the coronal plane with anteroposterior lengthening 2.
- This configuration is strongly associated with chronic obstructive pulmonary disease (COPD) and may be related to chronic bronchitis 2, 3, 4.
- The tracheal cartilage in patients with saber-sheath trachea is usually thickened and densely calcified, despite the appearance of weakening and collapse 2.
Clinical Implications
- Saber-sheath trachea is a useful sign of COPD, particularly when other convincing radiographic evidence is lacking 3, 4.
- The presence of saber-sheath trachea is correlated with the functional severity of airway obstruction, but not with other radiological signs of COPD 5.
- Evaluation of the trachea at chest radiography is recommended to identify saber-sheath trachea and assess its correlation with clinical and functional findings 5, 6.
Radiographic Findings
- The tracheal index, which is the ratio of the coronal to sagittal diameter of the trachea, is used to diagnose saber-sheath trachea 5, 6.
- A tracheal index of less than 2/3 or 0.67 is indicative of saber-sheath trachea 5.
- Computed tomography (CT) scans can be used to evaluate the trachea and diagnose saber-sheath trachea, with a high degree of sensitivity and specificity 2, 6.
Association with COPD
- Saber-sheath trachea is found in a significant proportion of patients with COPD, particularly those with severe airflow obstruction 5, 3.
- The presence of saber-sheath trachea is correlated with the severity of COPD, as measured by the GOLD stage and Tiffenau index 5.
- Saber-sheath trachea may be a useful marker of severe airflow obstruction in COPD patients 5.