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title: "Tracheal Dilatation" docid: "25c1fd77-52ff-4a56-b5c4-6ee1335ba369" authors:

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ESSENTIAL INFORMATION

  • Key Differential Diagnosis Issues

    • Tracheal wall composed of several layers: Mucosa, submucosa, cartilage or muscle, and adventitia
    • Horseshoe-shaped bands of hyaline cartilage support anterior and lateral tracheal walls
    • Posterior tracheal wall lacks cartilage and is supported by band of smooth muscle
    • During expiration: Anterior bulging of posterior wall of intrathoracic trachea and ↓ of tracheal AP diameter by 32%
    • Tracheal dilatation - Women - Tracheal transverse diameter > 21 mm, sagittal diameter > 23 mm - Men - Tracheal transverse diameter > 25 mm, sagittal diameter > 27 mm - Tracheal index: Coronal diameter/sagittal diameter measured 1 cm above aortic arch - Normal index ~ 1

  • Helpful Clues for Common Diagnoses

    • Upper Lobe Fibrosis - Retraction of tracheobronchial walls - Tuberculosis - Sarcoidosis - Hypersensitivity pneumonitis
    • Overdistention of Endotracheal Tube Cuff - Endotracheal tube or tracheostomy cannula cuff should not result in tracheal wall bulging - Endotracheal cuff located 2 cm from distal end - Overinflation of balloon to 1.5x diameter of normal trachea is associated with tracheal injury
    • Saber-Sheath Trachea - ↓ in coronal diameter of intrathoracic trachea associated with ↑ in sagittal diameter - Associated with COPD (95%) - Likely related to abnormal intrathoracic pressure
    • Tracheobronchomalacia - Condition characterized by excessive airway collapsibility caused by weakness of airway walls due to softening or destruction of supporting cartilage - Tracheomalacia patients have dilated and flaccid airway - ↓ in cross-sectional area > 70% during expiration compared with inspiration is generally considered diagnostic

  • Helpful Clues for Less Common Diagnoses

    • Tracheal Diverticulum - Mucosal herniation through tracheal wall from ↑ intraluminal pressure - Right posterolateral tracheal wall near thoracic inlet - Between tracheal cartilaginous and muscular portions - Communication with tracheal lumen rarely identified
    • Mounier-Kuhn Syndrome - Atrophy of muscular and elastic tissues in walls of trachea and mainstem bronchi - More common in men - Tracheal diameter > 30 mm (81.2%) - Bronchiectasis (48.6-57.6%) - Tracheal wall corrugated due to mucosa herniating between tracheal rings

References

Selected References

  1. Gayer G: Tracheal diverticula. Semin Ultrasound CT MR. 37(3):190-5, 2016
  2. Chung JH et al: CT of diffuse tracheal diseases. AJR Am J Roentgenol. 196(3):W240-6, 2011

Images

Selected Images

Axial HRCT of a 62-year-old man with upper lobe-predominant fibrosis from chronic hypersensitivity pneumonitis shows tracheal dilatation and upper lobe predominant honeycombing . Upper Lobe Fibrosis Axial HRCT of a 62-year-old man with upper lobe-predominant fibrosis from chronic hypersensitivity pneumonitis shows tracheal dilatation and upper lobe predominant honeycombing .

Axial HRCT of a 62-year-old man with upper lobe-predominant fibrosis from chronic hypersensitivity pneumonitis shows tracheal dilatation and upper lobe predominant honeycombing . Upper Lobe Fibrosis Axial HRCT of a 62-year-old man with upper lobe-predominant fibrosis from chronic hypersensitivity pneumonitis shows tracheal dilatation and upper lobe predominant honeycombing .

Coronal CT (minIP reformation) of the same patient shows dilatation of the trachea and mainstem bronchi . This phenomenon is thought to be related to traction exerted by surrounding pulmonary fibrosis similar to traction bronchiectasis and bronchiolectasis seen in the same process. Upper Lobe Fibrosis Coronal CT (minIP reformation) of the same patient shows dilatation of the trachea and mainstem bronchi . This phenomenon is thought to be related to traction exerted by surrounding pulmonary fibrosis similar to traction bronchiectasis and bronchiolectasis seen in the same process.

Frontal chest radiograph of an intubated patient demonstrates bulging of the tracheal wall secondary to overdistension of the endotracheal tube cuff. Overdistention of Endotracheal Tube Cuff Frontal chest radiograph of an intubated patient demonstrates bulging of the tracheal wall secondary to overdistension of the endotracheal tube cuff.

Coronal CT (minIP reformation) of a patient with tracheostomy cannula shows bulging of the tracheal wall by overdistension of the endotracheal tube cuff. Dilatation of the trachea from overdistention of an endotracheal tube cuff or tracheostomy cannula often results in tracheal injury with increased risk of subsequent tracheal stenosis. Overdistention of Endotracheal Tube Cuff Coronal CT (minIP reformation) of a patient with tracheostomy cannula shows bulging of the tracheal wall by overdistension of the endotracheal tube cuff. Dilatation of the trachea from overdistention of an endotracheal tube cuff or tracheostomy cannula often results in tracheal injury with increased risk of subsequent tracheal stenosis.

Composite image with axial NECT at the thoracic inlet (left) and axial NECT at a lower level (right) of a patient with COPD shows the normal shape of the extrathoracic trachea and the saber-sheath configuration of the intrathoracic trachea. Saber-Sheath Trachea Composite image with axial NECT at the thoracic inlet (left) and axial NECT at a lower level (right) of a patient with COPD shows the normal shape of the extrathoracic trachea and the saber-sheath configuration of the intrathoracic trachea.

Axial NECT of a 59-year-old woman with tracheal diverticulum demonstrates a right paratracheal air collection . Note the diminutive and subtle connection with the trachea . Tracheal Diverticulum Axial NECT of a 59-year-old woman with tracheal diverticulum demonstrates a right paratracheal air collection . Note the diminutive and subtle connection with the trachea .

Sagittal NECT (MIP reformation) of a patient with Mounier-Kuhn syndrome shows tracheal dilatation with abundant characteristic tracheobronchial diverticula . Tracheobronchial dilatation leads to impaired airway secretion clearance associated with recurrent infection and cough. Mounier-Kuhn Syndrome Sagittal NECT (MIP reformation) of a patient with Mounier-Kuhn syndrome shows tracheal dilatation with abundant characteristic tracheobronchial diverticula . Tracheobronchial dilatation leads to impaired airway secretion clearance associated with recurrent infection and cough.

Coronal CECT minIP reformation of the same patient shows airway dilatation and the corrugated appearance due to mucosa herniating between tracheal rings. Mounier-Kuhn Syndrome Coronal CECT minIP reformation of the same patient shows airway dilatation and the corrugated appearance due to mucosa herniating between tracheal rings.

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