From the Guidelines
Tracheobronchial testing should start with CT of the chest either without or with IV contrast to evaluate both benign and neoplastic causes of airway stenosis, as recommended by the most recent guidelines 1.
Initial Evaluation
When evaluating suspected tracheal or bronchial stenosis, the initial imaging should include CT of the chest with or without IV contrast, as it provides valuable information on the extent and severity of the stenosis, as well as its relationship to surrounding structures 1.
- CT with IV contrast is particularly useful in depicting lesion enhancement and relationship to vessels, which is crucial in planning treatment.
- Radiography of the chest is also appropriate as a first step to exclude other respiratory diseases that can cause symptoms overlapping those of airway stenosis.
Pre- or Posttreatment Assessment
For pre- or posttreatment assessment of tracheal or bronchial stenosis, chest CT without or with IV contrast is usually appropriate and can be important in both planning surgical or bronchoscopic procedures and detection of posttreatment complications 1.
- Chest radiography is usually appropriate as an initial assessment of a wide range of potential posttreatment complications.
- FDG-PET/CT may be appropriate for pre- or posttreatment evaluation of airway neoplasms.
Specific Conditions
In the initial imaging evaluation of suspected tracheomalacia or bronchomalacia, CT chest without IV contrast with inspiratory and forced expiratory series is usually appropriate for detection of ECAC 1.
- CT neck and chest without IV contrast with inspiratory and expiratory series can be used to assess the full length of the trachea for expiratory collapse.
- For suspected bronchiectasis, chest radiography is usually appropriate for evaluation of associated conditions and exclusion of diseases that cause similar symptoms, while CT chest without IV contrast provides information about the extent, severity, and distribution of bronchiectasis 1.
Imaging Techniques
Modern multidetector CT can be used to image the entire trachea at end expiration or during forced expiration (dynamic expiratory imaging) 1.
- Optimal evaluation of the airways requires thin-section imaging with a slice thickness of 1.5 mm or thinner, and adequate breath holding at inspiration is also important to avoid respiratory motion artifacts 1.
From the Research
Tracheobronchial Testing Overview
- Tracheobronchial testing is a crucial diagnostic tool for evaluating the tracheobronchial tree, with various imaging modalities available, including conventional CT scanning, super high-resolution CT (SHR-CT) scanning, and virtual bronchoscopy (VB) 2.
- These imaging techniques can help identify obstructions and endoluminal lesions within the respiratory tract, providing valuable information for the detection and management of airway malignancies 2.
Imaging Modalities for Tracheobronchial Injuries
- Chest radiography and cervical and thoracic CT are the primary imaging modalities used in the acute setting and follow-up for tracheobronchial injuries 3.
- Understanding normal tracheobronchial anatomy and its protective features, as well as points of vulnerability, is essential for interpreting imaging findings and guiding treatment decisions 3.
Tracheostomy and Tracheobronchial Secretions
- Tracheostomy can facilitate the weaning process, reduce sedation levels, and improve secretions clearance in ICU patients requiring prolonged mechanical ventilation 4.
- However, tracheostomy is associated with complications, such as tracheal stenosis, and the timing of the procedure remains a subject of debate 4.
- Non-invasive management of tracheobronchial secretions using devices like the Expiratory Flow Accelerator (EFA) may be effective in reducing the need for daily suctions in tracheostomised patients 5.
Diagnostic Techniques for Pneumonia
- Various diagnostic strategies are available for pneumonia, including clinical criteria, chest radiography, and microbiological cultures, but each has its limitations 6.
- Fiberoptic bronchoscopy appears to be a satisfactory technique for diagnosing pneumonia, particularly when an invasive approach is being considered 6.