CTICasesSubglottic and Tracheal Narrowing with Tracheomalacia Post-Inhalation Injury
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Imaging findings
The radiograph shows focal atelectasis in the lingular division. CT reveals focal subglottic tracheal narrowing with a triangular configuration, which becomes markedly more narrowed and slit-like on expiration, suggestive of tracheomalacia. A second area of tracheal narrowing inferiorly also exhibits a triangular configuration and slit-like appearance on expiration. The atelectatic lingular lung shows tubular opacities consistent with mucus accumulation behind an obstruction in the superior segmental bronchus. Bronchoscopy confirmed severe, A-shaped narrowing. The narrowing looks similar to post-tracheostomy stenosis, but the patient had prolonged intubation instead.
Key takeaways
Inhalation injury from a house fire and prolonged intubation can lead to significant tracheal stenosis and tracheomalacia, presenting as focal subglottic and tracheal narrowing with a triangular or 'sab-sheath' configuration, exacerbated on expiration. Associated findings may include obstructive atelectasis due to mucus plugging. Surgical resection and end-to-end anastomosis may be necessary for treatment.
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