CTICasesTracheobronchomalacia with Airway Calcifications in a Cartilaginous Inflammatory Disease
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Imaging findings
Inspiratory CT showed a lunate-shaped trachea with diffuse, significant attenuation of the proximal main stem bronchi, which was more dramatic towards the lower portions. Nodular thickening of the more distal bronchi and bronchiectasis were also present. Expiratory images demonstrated areas of air trapping and more severe dynamic airway collapse. Mediastinal lymphadenopathy (tracheal, AP window, subcarinal, bilateral hilar) with calcifications, some with an eggshell appearance, was noted. These findings progressed over 10 years, leading to more significant calcifications and air trapping in the entire left lung.
Key takeaways
Progressive dyspnea associated with diffuse airway wall thickening, calcifications (sometimes eggshell), tracheomalacia, and bronchomalacia is characteristic of chronic inflammatory diseases affecting cartilage, such as Relapsing Polychondritis. This condition leads to irreversible airway damage and requires intervention for progressive airway compromise. Steroid treatment may have limited efficacy in advanced stages.
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