Tracheal and Bronchial Neoplasms

Update on Multidetector Computed Tomography Imaging of the Airways

“…These tumors are well circumscribed and smoothly marginated, without evidence for extraluminal extension or mediastinal invasion. 53,57 Malignant airway tumors, in contrast, typically are flat or lobulated masses with indistinct or irregular margins, and are often larger in size, ranging from 2 to 4 cm. With advanced malignant neoplasms, extramural extension and mediastinal invasion may be identified.…”

“…With advanced malignant neoplasms, extramural extension and mediastinal invasion may be identified. 53,57 In 10% of malignant airway neoplasms, circumferential airway wall thickening and luminal narrowing may be visualized. 58 Although lymphadenopathy is more commonly seen with malignant tumors, distinguishing between reactive lymphadenopathy and neoplastic involvement may be difficult in the presence of postobstructive pneumonia, and biopsy is often required for accurate disease staging.…”

“…[54][55][56] Distinguishing between inflammatory polyps and other airway pseudotumors, including retained mucoid secretions, may also be challenging on MDCT. 57 However, repeat imaging in the supine position or after coughing maneuvers usually allows one to confidently distinguish between airway secretions and a fixed endoluminal lesion (Fig. 14).…”

“…14). 57 In addition, the application of PET-CT and virtual PET-CT bronchoscopy may also potentially address some of these limitations in the future. 36,37 MDCT imaging can determine the amenability of an airway neoplasm to complete surgical resection.…”

“…In patients who are regarded as inoperable, MDCT can help determine whether these patients are candidates for airway stenting by assessing the patency of the airways distal to the tumor. 57 Although MDCT is a sensitive modality for detecting the presence of central airway neoplasms, an exact diagnosis can rarely be established on MDCT imaging features alone. Certain MDCT imaging features, however, can be used to classify an airway tumor as benign or malignant.…”