Multimodality Imaging of Tracheobronchial Disorders in Children

Abstract

The trachea and bronchial airways in children are subject to compromise by a number of extrinsic and intrinsic conditions, including congenital, inflammatory, infectious, traumatic, and neoplastic processes. Stridor, wheezing, and respiratory distress are the most common indications for imaging of the airway in children. Frontal and lateral chest and/or neck radiography constitute the initial investigations of choice in most cases. Options for additional imaging include airway fluoroscopy, contrast esophagography, computed tomography (CT), and magnetic resonance (MR) imaging. Advanced imaging techniques such as dynamic airway CT, CT angiography, MR angiography, and cine MR imaging are valuable for providing relevant vascular and functional information in certain settings. Postprocessing techniques such as multiplanar reformatting, volume rendering, and virtual bronchoscopy assist in surgical planning by providing a better representation of three-dimensional anatomy. A systematic approach to imaging the airway based on clinical symptoms and signs is essential for the prompt, safe, and accurate diagnosis of tracheobronchial disorders in children.

Tracheal and bronchial tumors

“…In literature great confusion exists about their real prevalence. Several studies report a clear predominance of the malignant forms (65% of cases, approximately) but infantile hemangioma and papilloma are often excluded in these epidemiological analyses (3,5,6).…”

“…Airway involvement is rarely described but it can result in severe respiratory obstruction. Since most of them regress spontaneously, endoscopic or surgical excision is required only in case of involvement of vital structures (3).…”

“…In the former group, the most common histological entities are represented by infantile hemangioma and squamous papilloma, while inflammatory pseudotumors, leiomyomas, granular cell tumor, juvenile xanthogranuloma, tracheal lipoblastoma and laryngotracheal chondromas occur more sporadically. The latter group includes carcinoids, mucoepidermoid carcinomas and less frequently rhabdomyosarcoma, leiomyosarcoma and adenoid cystic carcinoma (2,3). Because of their low prevalence in the paediatric age and the absence of specific signs and symptoms, primary tracheobronchial tumors are often not suspected or misdiagnosed.…”

Spirometer-controlled cine magnetic resonance imaging used to diagnose tracheobronchomalacia in paediatric patients

“…However cine-CT to detect TBM exposes the patient to ionising radiation [1], which is a more significant problem for children than adults because they are more susceptible to the harmful effects of ionising radiation [10][11][12][13][14]. Cine-magnetic resonance imaging (MRI) might be an attractive, radiation-free alternative to cine-CT to diagnose TBM [15][16][17][18][19]. Recent improvements in MR technology (ultrafast imaging) allow dynamic evaluations of the central airway dimensions (cine-MRI) [15].…”

“…A MRI compatible spirometer was recently developed and tested [20]. To our knowledge, spirometer controlled cine-MRI has not been applied before in TBM assessment [16,18].…”