Chest
Volume 131, Issue 3, March 2007, Pages 758-764
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Original Research: Interventional Pulmonology
Comparison of Dynamic Expiratory CT With Bronchoscopy for Diagnosing Airway Malacia: A Pilot Evaluation

https://doi.org/10.1378/chest.06-2164Get rights and content

Abstract

Objective:To assess the accuracy of dynamic expiratory CT for detecting airway malacia using bronchoscopy as the diagnostic “gold standard.”

Materials and methods:A computerized hospital information system was used to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at our institution during a 19-month period. CT was performed within 1 week of bronchoscopy. All patients were scanned with a standard protocol, including end-inspiratory and dynamic expiratory volumetric imaging, using an eight-detector multislice helical CT scanner. For both CT and bronchoscopy, malacia was defined as ≥ 50% expiratory reduction of the airway lumen. CT and bronchoscopic findings were subsequently jointly reviewed by the radiologist and bronchoscopist for concordance.

Results:Twenty-nine patients (12 men and 17 women; mean age, 60 years; range, 36 to 79 years) comprised the study cohort. CT correctly diagnosed malacia in 28 of 29 patients (97%). The most common presenting symptoms were dyspnea in 20 patients (69%), severe or persistent cough in 16 patients (55%), and recurrent infection in 7 patients (24%). The estimated radiation dose (expressed as dose-length product) for the dual-phase study is 508 mGy-cm, which is comparable to a routine chest CT.

Conclusion:Dynamic expiratory CT is a highly sensitive method for detecting airway malacia and has the potential to serve as an effective, noninvasive test for diagnosing this condition.

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Subjects

Our hospital institutional review board approved the review of radiologic and clinical data for this study. Informed consent was not required for this retrospective analysis, but patient confidentiality was protected. This study was compliant with the requirements of the Health Insurance Portability and Accountability Act.

We used our computerized hospital information system to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at

Results

The final study cohort was comprised of 29 patients (17 women and 12 men; mean age, 60 years; range, 36 to 79 years). CT findings were concordant with bronchoscopic findings for the presence and distribution of airway malacia in 28 of 29 patients (97%) [Figure 2, Figure 3, Figure 4]. CT was concordant with bronchoscopy regarding the distribution of malacia in these 28 cases: diffuse tracheobronchomalacia in 23 cases (82%), bronchomalacia in 3 cases (11%), and tracheomalacia in 2 cases (7%) [

Discussion

Acquired tracheomalacia has been increasingly recognized as a relatively common but underdiagnosed cause of chronic respiratory symptoms.1, 3, 4, 11, 15Bronchoscopic visualization of dynamic airway collapse is the current “gold standard” for diagnosis, but it is an invasive technique with small but inherent risks. Pulmonary function testing may provide supportive evidence of this condition, but it is not diagnostic.3Because it is a functional abnormality that cannot be diagnosed on routine

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The authors do not report any conflicts of interest related to the topic discussed in this article.

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