CTICasesTracheobronchomalacia (Severe)
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Imaging findings
Inspiratory CT images show a slightly enlarged trachea with a somewhat unusual configuration. Expiratory dynamic imaging, performed at three levels, demonstrates dramatic tracheobronchomalacia with complete obliteration of the tracheal lumen at the level of the aortic arch, far exceeding 75-80% loss of cross-sectional area. The tracheal cartilages are markedly flattened, taking on a crescentic, 'indented' appearance, suggesting underlying cartilage laxity, in addition to excessive collapse of the posterior membrane. The main bronchi also show similar severe expiratory collapse.
Key takeaways
Severe tracheobronchomalacia is dramatically demonstrated on expiratory dynamic CT, showing extensive tracheal and bronchial collapse. The characteristic flattening of tracheal cartilages, in addition to posterior membrane laxity, suggests a structural weakness that may have a congenital component or be exacerbated by long-standing conditions like asthma and chronic inhaled steroid use. Pulmonary function tests are crucial for correlation with these imaging findings.
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