Airways Flashcards
ddx for non neoplastic tracheal thickening
polychondritis, tracehobronchopathia osteochondroplastica, TB, amyloidosis, wegener granulomatosis, sarcoid
relapsing polychondritis
inflammation of cartilaginous structures (ear, nose, larynx, trachea/bronchi)
middle aged women
smooth tracheal bronchial wall thickening with SPARING OF POSTERIOR MEMBRANOUS trachea
ddx for tracheal thickening with sparing of posterior trachea
relapsing polychondritis and tracheobronchopathia osteochondroplastica
tracheobronchopathia osteochondroplastica (TPO)
submucosal calcified osteocartilaginous nodules along tracheal walls
benign
TB airway
endobronchial spread can cause smooth concentric narrowing of long segments of airway (>3cm)
distal trachea and proximal bronchi
amyloidosis airway
irregular narrowing of airways due to submucosal amyloid deposition
posterior membrane involved
wegener granulomatosis
large airway involvement; usually subglottic tracheal stenosis with circumferential mucosal thickening
sarcoidosis airway
smooth stenosis to nodular or mass like apperance
tracheal involvement rare
causes of focal non-neoplastic tracheal stenosis/wall thickening
intubation/tracheostomy; Behcet and Crohn disease
bronchiectasis
progressive, irreversible dilation of cartilage containing bronchi
bronchial wall injury, lumen obstruction, traction from adjacent fibrosis
causes of bronchiectasis
- cystic fibrosis, Kartagener
- recurrent pneumonia
- bronchocentric infection (TB, atypical mycobacteria)
- immune response (ABPA, vasculitis)
- impaired immunity (congenital immunodeficiency, transplants, agammaglobulinemia)
- congenital connective tissue disorder (Mounier Kuhn, Williams-Campbell)
Mounier Kuhn
connective tissue disorder; tracheobronchomealy leading to recurrent pneumonia
Williams-Campbell
rare disorder
distal bronchial cartilage; sequelae of viral infection
cystic fibrosis vs post infectious imaging
CF: upper lobe predominant
viral: lower lobe predominant
types of bronchiectasis, morphology
cylindrical: mild bronchial dilation
varicose: moderate; beaded/irregular bronchi
cysts: severe; enlarged/ballooned with formation of multple cysts that may not connect to airways
signet ring sign bronchi
dilated bronchus adjacent to normal pulmonary artery branch
broncholithiasis
rare disorder of calcified/ossified material within bronchial lumen; adjacent calcified granulomatous LN
nonproductive cough, hemoptysis, air trapping
emphysema
destruction of alveolar walls»_space; irreversible enlargement of distal airspaces»_space; fibrosis
increased elastase in smokers (produced by macrophages/neutrophils); or decreased of alpha 1 antitrypsin (neutralizing enzyme) can result in lung destruction/emphysema
centrilobular emphysema
smoking related lung disease ; upper lobes
center of secondary pulmonary nodule
paraseptal emphysema
subpleural location, predisposes to pneumothorax
panacinalr/panlobular emphysema
lower lobes
most common airway central tumors
squamous cell carcinoma, adenoid cystic carcinoma
less common: carcinoid, mucoepidermoid carcinoma, tracheal lymphoma, endobronchial mets, malignancy
squamous cell carcinoma: airays
smoking associated
polypoid intraluminal tracheal mass; may invade esophagus and cause TEF
adenoid cystic carcinoma
low grade malignancy; pts in 40s without smoking history
perineural/submucosal spread; intense FDG uptake
submucosal mass that infiltrates tracheal wall and mediastinal fat; also can cause circumferential tracheal/bronchial thickening causing airway stenosis
