Alterações difusas da traquéia: aspectos na tomografia computadorizada

Abstract

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

Complicated tracheo-bronchial papillomatosis

“…Hemoptysis is a common presentation in patients with respiratory papillomatosis. Hence, it is usually confused with active pulmonary tuberculosis [23] . In the juvenile form of the respiratory papillomatosis, the clinical presentation tends to be more severe due to rapid growth of the lesions and airway obstruction [4,5] .…”

“…These lesions usually have centrilobular distribution, and are scattered throughout the lungs. Some nodules may enlarge in size and transform into air-filled cysts leading to the formation of large cavities with irregular internal borders and thick or thin walls [7,9,23] . The nodular lesions in the lung usually affect more the basal and posterior parts.…”

“…It includes many of focal and diffuse central airway diseases [4,20] . Focal lesions may resemble tracheal neoplasms, post-intubation stenosis, traumatic lesions, some infectious diseases, and the systemic diseases that may involve the airways and result in focal tracheabronchial stenosis [4,20,23] . The diffuse pulmonary papillomatous lesions should be differentiated from…”

Tuberculosis: tracheal involvement

“…Tracheobronchial tuberculosis mainly affects younger, female patients, its incidence peaking in the third decade of life. The disease can affect the greater part of the trachea, also affecting the bronchi, or it can affect just a small segment of the trachea or of one bronchus (4,5) . The clinical presentation can be insidious, simulating bronchogenic carcinoma, or acute, with a profile similar to that of asthma, foreign body aspiration, or pneumonia.…”

“…The differential diagnoses include other diseases affecting the trachea, not only those presenting localized involvement- such as primary tracheal neoplasms, injuries of traumatic origin, and some infectious diseases-but also those presenting diffuse involvement-amyloidosis, tracheobronchopathia osteochondroplastica, relapsing polychondritis, laryngotracheobronchial papillomatosis, tracheobronchomegaly, neurofibromatosis, Wegener's granulomatosis, lymphoma, and paracoccidioidomycosis (5,7-12) .…”