5 A Abnormalities of The Trachea BRONCHATLAS Prepared

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5 A: Abnormalities of The Trachea BRONCHATLAS© Prepared By www. Bronchoscopy. org 5/26/17 All

5 A: Abnormalities of The Trachea BRONCHATLAS© Prepared By www. Bronchoscopy. org 5/26/17 All Rights Reserved, 2017 1

Bronchoscopy reports: The Trachea The bronchoscopy report should tell a story that everyone can

Bronchoscopy reports: The Trachea The bronchoscopy report should tell a story that everyone can read and understand the same way. Morphology: Caliber, patency, shape, normal variants Appearance: Normal, abnormal Mucosa: Normal, color, edematous, friable Abnormalities: Location, type, extent, associated malacia, number of cartilaginous rings involved, posterior wall (dynamic collapse, excessive dynamic collapse) Secretions: 5/26/17 Abundance, location, type, color All Rights Reserved, 2017 2

Various tracheal morphologies Horseshoe trachea 5/26/17 Fixed Saber sheath (TI<0. 6) All Rights Reserved,

Various tracheal morphologies Horseshoe trachea 5/26/17 Fixed Saber sheath (TI<0. 6) All Rights Reserved, 2017 Tracheomegaly 3

Necrotizing tracheitis Noticed in patient while on mechanical ventilation 5/26/17 All Rights Reserved, 2017

Necrotizing tracheitis Noticed in patient while on mechanical ventilation 5/26/17 All Rights Reserved, 2017 4

Cartilaginous tracheal abnormalities Bony spur 5/26/17 Prominent thin cartilage All Rights Reserved, 2017 Triangular

Cartilaginous tracheal abnormalities Bony spur 5/26/17 Prominent thin cartilage All Rights Reserved, 2017 Triangular (with bony spur) 5

Osteochondroplastica * Firm intraluminal cartilaginous nodules * Courtesy P. Grynblatt, Argentina 5/26/17 All Rights

Osteochondroplastica * Firm intraluminal cartilaginous nodules * Courtesy P. Grynblatt, Argentina 5/26/17 All Rights Reserved, 2017 6

Osteochondroplastica benign appearance Posterior membrane Cartilage protuberance 5/26/17 All Rights Reserved, 2017 7

Osteochondroplastica benign appearance Posterior membrane Cartilage protuberance 5/26/17 All Rights Reserved, 2017 7

Infiltrative tracheal abnormalities Amyloidosis involves larynx, trachea and carina 5/26/17 All Rights Reserved, 2017

Infiltrative tracheal abnormalities Amyloidosis involves larynx, trachea and carina 5/26/17 All Rights Reserved, 2017 8

Tracheobronchomalacia Saber-sheath type. Note collapse of lateral walls during expiration 5/26/17 All Rights Reserved,

Tracheobronchomalacia Saber-sheath type. Note collapse of lateral walls during expiration 5/26/17 All Rights Reserved, 2017 Crescent type. Note flattened anterior wall during expiration 9

Tracheobronchomegaly with malacia With chronic accumulation of purulent secretions 5/26/17 All Rights Reserved, 2017

Tracheobronchomegaly with malacia With chronic accumulation of purulent secretions 5/26/17 All Rights Reserved, 2017 10

Excessive dynamic airway collapse Posterior wall bulges inward during expiration while anterior wall remains

Excessive dynamic airway collapse Posterior wall bulges inward during expiration while anterior wall remains intact* *Courtesy H. Dutau, France 5/26/17 All Rights Reserved, 2017 11

Tracheal stenosis ■ ■ Web-like subglottic stricture Circumferential subglottic stenosis 5/26/17 All Rights Reserved,

Tracheal stenosis ■ ■ Web-like subglottic stricture Circumferential subglottic stenosis 5/26/17 All Rights Reserved, 2017 12

Pseudoglottic stenosis ■ ■ ■ Usually post tracheostomy Fracture of cartilage Malacia of cartilage

Pseudoglottic stenosis ■ ■ ■ Usually post tracheostomy Fracture of cartilage Malacia of cartilage 5/26/17 All Rights Reserved, 2017 13

Idiopathic tracheal stenosis* * ■ ■ ■ Circumferential stenosis Subglottic Female predominance *Courtesy J.

Idiopathic tracheal stenosis* * ■ ■ ■ Circumferential stenosis Subglottic Female predominance *Courtesy J. Janssen 5/26/17 All Rights Reserved, 2017 14

Tracheal tumors ■ Adenoid cystic carcinoma ■ Squamous cell carcinoma 5/26/17 All Rights Reserved,

Tracheal tumors ■ Adenoid cystic carcinoma ■ Squamous cell carcinoma 5/26/17 All Rights Reserved, 2017 15

Malignant central airway obstruction Invading Thyroid cancer with extrinsic compression 5/26/17 Necrotic Intrluminal, exophytic

Malignant central airway obstruction Invading Thyroid cancer with extrinsic compression 5/26/17 Necrotic Intrluminal, exophytic Squamous cell cancer obstructing Right main bronchus All Rights Reserved, 2017 16

Intraluminal exophytic lesions Necrotic Squamous cell 5/26/17 Nodular Adenocarcinoma Nodular Squamous cell All Rights

Intraluminal exophytic lesions Necrotic Squamous cell 5/26/17 Nodular Adenocarcinoma Nodular Squamous cell All Rights Reserved, 2017 17

Extrinsic compression ■ ■ Compression Left Main Bronchus from Esophageal cancer Compression trachea (with

Extrinsic compression ■ ■ Compression Left Main Bronchus from Esophageal cancer Compression trachea (with invasion) from Adenoid Cystic Carcinoma 5/26/17 All Rights Reserved, 2017 18

Carina adenopathy ■ ■ Subcarina and posterior carina adenopathy Subcarina and Pretracheal adenopathy 5/26/17

Carina adenopathy ■ ■ Subcarina and posterior carina adenopathy Subcarina and Pretracheal adenopathy 5/26/17 All Rights Reserved, 2017 19

Neoplasm of carina Adenocarcinoma obstructing left and right main bronchi and lower third of

Neoplasm of carina Adenocarcinoma obstructing left and right main bronchi and lower third of trachea above the carina. 5/26/17 All Rights Reserved, 2017 20

Extrinsic compression from esophageal cancer and esophageal stent Esophageal stent Compression Left Main Bronchus

Extrinsic compression from esophageal cancer and esophageal stent Esophageal stent Compression Left Main Bronchus 5/26/17 All Rights Reserved, 2017 Silicone stent for palliation 21

Miscellaneous airway findings Tracheo-esophgeal fistula 5/26/17 Foreign body All Rights Reserved, 2017 Tracheal bronchus

Miscellaneous airway findings Tracheo-esophgeal fistula 5/26/17 Foreign body All Rights Reserved, 2017 Tracheal bronchus 22

Repaired tracheocele with pus-filled pouch causing recurrent pneumonia Pouch Inside pouch 5/26/17 All Rights

Repaired tracheocele with pus-filled pouch causing recurrent pneumonia Pouch Inside pouch 5/26/17 All Rights Reserved, 2017 23

False track (tracheo-mediastinal fistula caused by tracheotomy tube Trachea False track 5/26/17 All Rights

False track (tracheo-mediastinal fistula caused by tracheotomy tube Trachea False track 5/26/17 All Rights Reserved, 2017 24

Granulation tissue growing through fenestration of tracheotomy tube Patient complains of cough, difficulty speaking,

Granulation tissue growing through fenestration of tracheotomy tube Patient complains of cough, difficulty speaking, and occasional hemoptysis 5/26/17 All Rights Reserved, 2017 25

Step by Step© BRONCHATLAS© & You. Tube Instructional videos This presentation is part of

Step by Step© BRONCHATLAS© & You. Tube Instructional videos This presentation is part of a multidimensional competency-oriented curriculum for Flexible Bronchoscopy. Our goal is to eliminate patient suffering caused by unequal physician expertise and on-the-job training. 5/26/17 All Rights Reserved, 2017 26

All efforts are made by Bronchoscopy International to maintain currency of online information. Multimedia

All efforts are made by Bronchoscopy International to maintain currency of online information. Multimedia presentations and videos can be cited as: Bronchoscopy International: Bronch. Atlas©, an Electronic On-Line Multimedia Slide Presentation. http: //www. Bronchoscopy. org/Bronchatlas/htm. Published 2017 (Please add “Date Accessed”). BRONCHATLAS© Thank you 5/26/17 All Rights Reserved, 2017 27

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