Prevalence of Tracheal Collapse in an Emphysema Cohort as Measured With End-expiration CT

Ochs, Robert A.; Petkovska, Iva; Kim, Hee Jin; Abtin, Fereidoun; Brown, Matthew S.; Goldin, Jonathan G.

doi:10.1016/j.acra.2008.05.020

Cited by 33 publications

(22 citation statements)

References 18 publications

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“…These fi ndings have potential relevance to the increasingly common application of multidetector CT scan to assess forced expiratory tracheal collapse in patients at risk for tracheomalacia. 23,24 Just as sex and age infl uence the interpretation of pulmonary function tests, our results suggest that these same characteristics should be considered when assessing forced expiratory airway collapse for suspected tracheomalacia.…”

Section: Tracheal Measurementsmentioning

confidence: 99%

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

O’Donnell

Litmanovich

Loring

et al. 2012

Chest

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A lthough much is known about changes in lung dimensions during various respiratory maneuvers, there is relatively little data regarding the normal range of forced expiratory airway collapse. 1,2 With growing interest in the use of CT scanning to evaluate forced expiratory collapse of the trachea in patients with suspected tracheomalacia, 3 there is a need to determine whether a single threshold of percentage forced expiratory collapse (%collapse) can be applied in the diagnostic evaluation of this disorder.Stern et al, 1 in a study of 10 healthy young men aged 24 to 31 years, reported a mean 35% forced expiratory collapse of the intrathoracic trachea. In contrast, we recently reported on a sample of 51 healthy men and women aged 25 to 75 years with an approximate 55% average forced expiratory collapse of the intrathoracic trachea. 2 We wondered whether this Background: A recent estimate for the normal range of forced expiratory tracheal collapse differs substantially from that in an earlier study performed with comparable measurement methods. Given differences in subject characteristics between the two samples, we hypothesized that these discrepant fi ndings may refl ect a heretofore unrecognized association between forced expiratory tracheal collapse and age or sex. Methods: We enrolled 40 female and 41 male healthy volunteers between 25 and 75 years of age who were without respiratory symptoms or known risk factors for tracheomalacia. Subjects underwent low-dose CT scanning at total lung capacity (TLC) and during forced exhalation (Expdyn) with spirometric monitoring and coaching. Percentage forced expiratory collapse was regressed on age for the total sample and separately within sex. Results: Mean tracheal cross-sectional area (CSA) was 2.54 cm 2 Ϯ 0.57 cm 2 at TLC and 1.15 cm 2 Ϯ 0.53 cm 2 at Expdyn. Mean percentage forced expiratory collapse (%collapse) was 54% Ϯ 20%. Men aged 24 to 31 years (n 5 12) had mean %collapse of 36% Ϯ 19%, comparable to results previously reported for similarly aged men (35% Ϯ 18%). Men, but not women, showed a signifi cant positive correlation ( R 2 5 0.40, P , .001) between %collapse and age. Older men had both greater CSA at TLC ( P 5 .02) and smaller CSA at Expdyn ( P 5 .001) than younger men. Conclusions: Men exhibit positive age dependence of forced expiratory tracheal collapse. The infl uence of age and sex on forced expiratory tracheal collapse should be considered in the diagnostic evaluation of expiratory dynamic airway collapse and/or tracheomalacia.CHEST 2012; 142(1):168-174

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Section: Tracheal Measurementsmentioning

confidence: 99%

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

O’Donnell

Litmanovich

Loring

et al. 2012

Chest

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“…In our study, the area with maximal collapse is based on measurements of the cross-sectional areas from the carina to the thoracic inlet. In a study by Lee et al, a radiologist determined the maximal collapse visually, while Ochs et al used a technique similar to ours that minimizes the interobserver variation [13,14]. An important problem with this method is that patients with only minor localized collapse are also included, and the impact of this is unknown and questionable [15].…”

Section: Discussionmentioning

confidence: 99%

Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods

Nyegaard

Bendstrup

Dahl

et al. 2017

European Clinical Respiratory Journal

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Background: The gold standard for diagnosing excessive tracheal collapse is still evaluation during bronchoscopy. Today, multidetector computed tomography (MDCT) is used to confirm a suspicion of abnormal tracheal collapse. There is no gold standard for computed tomography (CT) image analysis of tracheal collapse. Purpose: To evaluate four different methods for the diagnosis of tracheal collapse using the images obtained through MDCT to help clinicians evaluate the images in daily practice. Objectives: 374 consecutive high-resolution CT scans with full inspiratory and end-expiratory CT scans were retrospectively analyzed. Methods: The images were analyzed in four different ways. The degree of collapse was based on cross-sectional areas of individual locations or volumes of entire regions: (1) 1 cm above the carina, (2) the level of maximal collapse of the trachea, (3) the entire region from the carina to the thoracic inlet, and (4) the trachea and bronchial region as defined by the software. Results: We compared three existing and one new method for image analysis of tracheal collapse by MDCT. The prevalence of tracheal collapse varied from 10.7% to 19.5% in this cohort of patients suffering from mixed lung diseases when using an expiratory collapse of ≥50% as a threshold. The four methods were comparable with highly significant Pearsons correlation coefficients (0.764–0.856). However, the four methods identified different patients with collapse of ≥50%. There was no correlation between symptoms and the degree of collapse. Conclusion: The different methods identify tracheal collapse in different patients. Hence, the diagnosis of excessive tracheal collapse can not rely solely on MDCT images. Generally, there is a poor correlation between symptoms and the degree of collapse in the different methods. However, when using the maximal collapse, there is some correlation with symptoms. When in doubt regarding the diagnosis, further investigations, such as bronchoscopy, should be carried out.

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“…In adults, common acquired causes include prolonged intubation, severe emphysematous disease, chronic inflammation and recurrent respiratory infections 12–14. Refuting the argument that intubation alone may have caused the above cases TBM, is the short duration of intubation (3–4 h) and that there was observed diffuse tracheal and bronchial weakness, whereas typically, intubation associated TBM is characterised by a segmental weakness from localised pressure necrosis from the cuff 12 14.…”

Section: Discussionmentioning

confidence: 99%

Psittacosis infection and tracheobronchomalacia in a patient undergoing thyroidectomy

Dixon

Díaz‐Cano

Schulte³

2011

Case Reports

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Prevalence of Tracheal Collapse in an Emphysema Cohort as Measured With End-expiration CT

Cited by 33 publications

References 18 publications

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods

Psittacosis infection and tracheobronchomalacia in a patient undergoing thyroidectomy

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