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2017 ; 8
(2
): 255-270
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Central airway pathology: clinic features, CT findings with pathologic and
virtual endoscopy correlation
#MMPMID28197883
Barnes D
; Gutiérrez Chacoff J
; Benegas M
; Perea RJ
; de Caralt TM
; Ramirez J
; Vollmer I
; Sanchez M
Insights Imaging
2017[Apr]; 8
(2
): 255-270
PMID28197883
show ga
OBJECTIVES: To describe the imaging features of the central airway pathology,
correlating the findings with those in pathology and virtual endoscopy. To
propose a schematic and practical approach to reach diagnoses, placing strong
emphasis on multidetector computed tomography (MDCT) findings. METHODS: We
reviewed our thoracic pathology database and the central airway pathology-related
literature. Best cases were selected to illustrate the main features of each
disease. MDCT was performed in all cases. Multiplanar and volume-rendering
reconstructions were obtained when necessary. Virtual endoscopy was obtained from
the CT with dedicated software. RESULTS: Pathological conditions affecting the
central airways are a heterogeneous group of diseases. Focal alterations include
benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse
abnormalities are divided into those that produce dilation and those that produce
stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the
mucosal layer and is an important diagnostic and therapeutic weapon. However,
assessing the deep layers or the adjacent tissue is not possible. MDCT and
post-processing techniques such as virtual bronchoscopy (VB) provide an excellent
evaluation of the airway wall. CONCLUSION: This review presents the complete
spectrum of the central airway pathology with its clinical, pathological and
radiological features. TEACHING POINTS: ? Dividing diseases into diffuse and
focal lesions helps narrow the differential diagnosis. ? Focal lesions with
nodularity are more likely to correspond to tumours. ? Focal lesions with
stenosis are more likely to correspond to inflammatory disease. ? Posterior wall
involvement is the main feature in diffuse lesions with stenosis.