Tracheomalacia

Preliminary Diagnosis: Tracheomalacia

I. What imaging technique is first-line for this diagnosis

• Dynamic airway fluoroscopy.

II. Describe the advantages and disadvantages of this technique for diagnosis of tracheomalacia.

Advantages

• Highly portable, inexpensive, and fast imaging modality.

• Highly sensitive for tracheomalacia

• Exposes patients to minimal ionizing radiation.

Disadvantages

• Low specificity for detailing findings of tracheomalacia and any underlying causes.

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• Less adept in detailing and defining the surrounding soft tissue and vascular structures compared with companion cross sectional imaging.

III. What are the contraindications for the first-line imaging technique?

• No specific contraindications exist.

IV. What alternative imaging techniques are available?

• CT of the chest (inspiratory and expiratory views) with IV contrast

• MR of the chest with IV contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tracheomalacia.

CT of the chest (inspiratory and expiratory views) with IV contrast

Advantages

• Highly sensitive and specific in detailing any underlying primary pathologic process or any secondary complications.

• Dynamic CT imaging is highly specific in diagnosing tracheomalacia.

• May be done quickly without sedation.

• Contrasted CT imaging is highly adept in ruling out vascular abnormalities and diagnosing underlying causes of tracheomalacia

Disadvantages

• Exposes patients to ionizing radiation.

• More expensive and less portable imaging study when compared to airway fluoroscopy.

MR of the chest with IV contrast

Advantages

• Highly sensitive and specific in detecting and characterizing tracheomalacia and any underlying secondary complications or etiologies.

• Offers exquisite detail of the surrounding soft tissues.

• Does not expose patients to ionizing radiation.

Disadvantages

• Offers limited evaluation of the surrounding osseous structures.

• May require sedation.

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest (inspiratory and expiratory views) with IV contrast

• May be contraindicated in pregnant patients.

• Relative contraindication to IV contrast in patients with renal failure or contrast allergy

MR of the chest with IV contrast

• Contraindicated in patients with non-MR compatible hardware.

• Relative contraindication to IV contrast in patients with renal failure

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