feat: Add new articles on Allergic Bronchopulmonary Aspergillosis, Finger-in-Glove Sign, and Tracheal Dilatation; update content index and document conversion script
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title: "Tracheal Dilatation"
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docid: "25c1fd77-52ff-4a56-b5c4-6ee1335ba369"
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breadcrumbs:
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- "Chest"
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- "Differential Diagnosis"
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- "Airways"
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- "General Imaging Patterns"
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- "Tracheal Dilatation"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Tracheal wall composed of several layers: Mucosa, submucosa, cartilage or muscle, and adventitia
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- Horseshoe-shaped bands of hyaline cartilage support anterior and lateral tracheal walls
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- Posterior tracheal wall lacks cartilage and is supported by band of smooth muscle
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- During expiration: Anterior bulging of posterior wall of intrathoracic trachea and ↓ of tracheal AP diameter by 32%
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- Tracheal dilatation
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- Women
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- Tracheal transverse diameter > 21 mm, sagittal diameter > 23 mm
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- Men
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- Tracheal transverse diameter > 25 mm, sagittal diameter > 27 mm
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- Tracheal index: Coronal diameter/sagittal diameter measured 1 cm above aortic arch
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- Normal index ~ 1
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- ## Helpful Clues for Common Diagnoses
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- **Upper Lobe Fibrosis**
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- Retraction of tracheobronchial walls
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- Tuberculosis
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- Sarcoidosis
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- Hypersensitivity pneumonitis
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- **Overdistention of Endotracheal Tube Cuff**
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- Endotracheal tube or tracheostomy cannula cuff should not result in tracheal wall bulging
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- Endotracheal cuff located 2 cm from distal end
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- Overinflation of balloon to 1.5x diameter of normal trachea is associated with tracheal injury
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- **Saber-Sheath Trachea**
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- ↓ in coronal diameter of intrathoracic trachea associated with ↑ in sagittal diameter
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- Associated with COPD (95%)
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- Likely related to abnormal intrathoracic pressure
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- **Tracheobronchomalacia**
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- Condition characterized by excessive airway collapsibility caused by weakness of airway walls due to softening or destruction of supporting cartilage
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- Tracheomalacia patients have dilated and flaccid airway
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- ↓ in cross-sectional area > 70% during expiration compared with inspiration is generally considered diagnostic
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- ## Helpful Clues for Less Common Diagnoses
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- **Tracheal Diverticulum**
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- Mucosal herniation through tracheal wall from ↑ intraluminal pressure
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- Right posterolateral tracheal wall near thoracic inlet
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- Between tracheal cartilaginous and muscular portions
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- Communication with tracheal lumen rarely identified
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- **Mounier-Kuhn Syndrome**
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- Atrophy of muscular and elastic tissues in walls of trachea and mainstem bronchi
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- More common in men
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- Tracheal diameter > 30 mm (81.2%)
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- Bronchiectasis (48.6-57.6%)
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- Tracheal wall corrugated due to mucosa herniating between tracheal rings
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