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

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: Abundance, location, type, color 5/26/17 All Rights Reserved, 2017

Various tracheal morphologies Horseshoe trachea Fixed Saber sheath (TI<0.6) Tracheomegaly 5/26/17 All Rights Reserved, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BRONCHATLAS© Step by Step© & YouTube 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

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