Transcript Part 5A - Abnormalities of the Trachea

5A: Abnormalities of The Trachea
BRONCHATLAS©
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Bronchoscopy reports: The Trachea
The bronchoscopy report should tell a story that everyone can read and
understand the same way.
Morphology:
Caliber, patency, shape, normal variants
Appearance:
Normal, abnormal
Mucosa:
Normal, color, edematous, friable
Abnormalities: Location, type, extent, associated malacia, number of
cartilaginous rings involved, posterior wall (dynamic
collapse, excessive dynamic collapse)
Secretions:
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Abundance, location, type, color
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Various tracheal morphologies
Horseshoe trachea
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Fixed Saber sheath
(TI<0.6)
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Tracheomegaly
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Necrotizing tracheitis
Noticed in patient
while on mechanical
ventilation
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Cartilaginous tracheal abnormalities
Bony spur
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Prominent thin
cartilage
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Triangular (with bony
spur)
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Osteochondroplastica
*
Firm intraluminal cartilaginous nodules
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* Courtesy
P. Grynblatt, Argentina
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Osteochondroplastica benign appearance
Posterior membrane
Cartilage protuberance
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Infiltrative tracheal abnormalities
Amyloidosis involves larynx, trachea and carina
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Tracheobronchomalacia
Saber-sheath type. Note collapse of
lateral walls during expiration
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Crescent type. Note
flattened anterior wall
during expiration
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Tracheobronchomegaly with malacia
With chronic accumulation of purulent secretions
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Excessive dynamic airway collapse
Posterior wall bulges inward during expiration
while anterior wall remains intact*
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*Courtesy
Dutau,
France
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Tracheal stenosis


Web-like subglottic stricture
Circumferential subglottic
stenosis
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Pseudoglottic stenosis



Usually post tracheostomy
Fracture of cartilage
Malacia of cartilage
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Idiopathic tracheal stenosis*
*



Circumferential stenosis
Subglottic
Female predominance
*Courtesy J. Janssen
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Tracheal tumors

Adenoid cystic carcinoma

Squamous cell carcinoma
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Malignant central airway
obstruction
Invading Thyroid cancer
with extrinsic compression
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Necrotic Intrluminal, exophytic
Squamous cell cancer obstructing
Right main bronchus
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Intraluminal exophytic lesions
Necrotic Squamous cell
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Nodular Adenocarcinoma Nodular Squamous cell
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Extrinsic compression


Compression Left Main
Bronchus from Esophageal
cancer
Compression trachea (with
invasion) from Adenoid Cystic
Carcinoma
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Carina adenopathy
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
Subcarina and posterior
carina adenopathy
Subcarina and Pretracheal
adenopathy
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Neoplasm of carina
Adenocarcinoma
obstructing left and right
main bronchi and lower
third of trachea above the
carina.
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Extrinsic compression from esophageal
cancer and esophageal stent
Esophageal
stent
Compression Left Main Bronchus
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Silicone stent for palliation
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Miscellaneous airway findings
Tracheo-esophgeal fistula
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Foreign body
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Tracheal bronchus
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Repaired tracheocele with pus-filled
pouch causing recurrent pneumonia
Pouch
Inside pouch
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False track (tracheo-mediastinal fistula
caused by tracheotomy tube
Trachea
False track
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Granulation tissue growing through
fenestration of tracheotomy tube
Patient complains of
cough, difficulty
speaking, and
occasional hemoptysis
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This presentation is part of a
comprehensive curriculum for
Flexible Bronchoscopy. Our goals are
to help health care workers become
better at what they do, and to
decrease the burden of procedurerelated training on patients.
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