Airway Disease

Question 1

DDx of Large Airway Dx

Answer 1

• Focal
  
  • neoplasm
  • infection
  • inflammatory
  • congeintal
  • trauma
  • miscellaneous
• Diffuse
  
  • same except no trauma

Question 2

Tracheal neoplasm

Answer 2

• squamous and adnoid cystic carcinoma 80%
• polypoid mass
• irregular wall thickening
• adenoid cystic carcinoma is more distal
• carcinoid - bronchial, enhancing

Question 3

Inflmmatory

Answer 3

• relapsing polychondritis
  
  • smooth tracheal/bronchial wall thickening
  • sparing of the posterior tracheal membrane
  • calcification, fibrosis, and narrowing
• wegeners granulomatosis
• fibrosing mediastinitis
  
  • histoplasmosis
  • pulmonary veins first to go
• sarcoidosis
  
  • most often peripheral airways
• inflammatory bowel disease
  
  • sclerosing tracheobronchitis

Question 4

Infection

more often chronic infections

Answer 4

• bacterial tracheitis
• TB - LMB
• fungus - aspergillus
• rhinoscleroma - tropical, klebsiella

Question 5

Congenital

Answer 5

• central airway malformation is associated with vascular malformation
• tracheal bronchus - RUL apical segment
• cardiac bronchus

Question 6

trauma

Answer 6

• tracheal rupture - pneumomediastinum, fallen lung sign
• tracheal stenosis
• mucosal ischemic injury

Question 7

Miscellaneous

Answer 7

• tracheobronchomalacia
  
  • 50% collapse on expiratory
• amyloidosis
  
  • circumferential, nodular calcfication, cobble-stoning
• tracheobronchopathia osteochondroplastica (TBO)
  
  • sparing posterior membrane
• tracheobronchomegaly
  
  • Mounier-Kuhn syndrome
  • congenital, COPD
• tracheal fistula

Question 8

Small airways

Answer 8

• membranous bronchioles
• terminal bronchioles
• repiratory bronchiols
• alveolar ducts and sacs

Question 9

Small airway disease

Direct signs

Answer 9

• centrilobular nodules
  
  • solid
  • tree-in-bud
  • groundglass
• bronchiolectasis
  
  • uncommon chronic fibrosis

Question 10

Small airway disease

Indirect signs

Answer 10

• Mosaic attenuation
  
  • inspiratory CT/HRCT
  • decreased attenuation and perfusion
  • follow lobule margins
  • DDx
    
    • Obliterative small aw dz
    • patchy ILD
    • occlusive vascular dz
• Air trapping
  
  • expiratory CT/HRCT
  • sharply defined patchwark

Question 11

Small airway disease

Classification

Answer 11

• Proliferative/cellular - nodules, tree-in-bud
• fibrotic - mosaic, air-trapping