Saber-sheath trachea in a patient with bronchiolitis obliterans syndrome after lung transplantation

Hayes, Don; Ho, Ballard

doi:10.1177/1479972308099990

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Intrathoracic coronal narrowing and sagittal widening of the trachea characterise saber-sheath trachea, which is commonly associated with severe obstructive lung diseases, for example, chronic bronchitis, emphysema, hyperinflation and bronchiolitis obliterans syndrome after lung transplantation 1. A tracheal index (the ratio between coronal and sagittal diameter of the trachea at the same level) of less than two-thirds has 92.9% specificity, but 39.1% sensitivity, to diagnose severe cases of COPD 2.…”

Section: Descriptionmentioning

confidence: 99%

Saber-sheath trachea in a patient with severe COPD

et al. 2016

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DESCRIPTIONAn 86-year-old man was evaluated for chronic cough and right lower lobe (RLL) mass. His medical history was significant for severe chronic obstructive lung disease (COPD). He had smoked one pack of cigarettes daily for 55 years. He had a barrel-shaped chest and diminished breath sounds in bilateral lungs were heard. CT of the chest noted RLL mass and abnormal configuration of the trachea (figure 1). Bronchoscopic examination showed an enlarged non-collapsible horseshoeshaped trachea (figure 2). Endobronchial ultrasound with fine-needle aspiration of the left paratracheal lymph nodes revealed squamous cell carcinoma. A diagnosis of stage IIIb lung cancer was established. The patient was referred to the oncology department, for further management.We demonstrate radiographic and bronchoscopic features of saber-sheath trachea in a patient with severe COPD and concurrent primary lung cancer. Intrathoracic coronal narrowing and sagittal widening of the trachea characterise saber-sheath trachea, which is commonly associated with severe obstructive lung diseases, for example, chronic bronchitis, emphysema, hyperinflation and bronchiolitis obliterans syndrome after lung transplantation.1 A tracheal index (the ratio between coronal and sagittal diameter of the trachea at the same level) of less than two-thirds has 92.9% specificity, but 39.1% sensitivity, to diagnose severe cases of COPD.2 The pathophysiological mechanisms of saber-sheath trachea are due to repetitive cartilaginous injury from excessive coughing, and elevated intrathoracic pressure. These mechanisms cause degeneration and ossification of the cartilage leading to chronic remodelling, calcification and bending of the tracheal cartilage.3 Cases of air leaking during endotracheal intubation were reported because the circular-shaped balloon could not approximate the sagittal elongation of the stiff tracheal wall.

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Section: Descriptionmentioning

confidence: 99%

Saber-sheath trachea in a patient with severe COPD

et al. 2016

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“…These results suggest that SST may be a consequence of the presence of chronic bronchitis. It is believed that this shape is a result of remodelling and fixation of the tracheal cartilage induced by chronic coughing and inflammation . These are very typical symptoms in COPD patients suffering from chronic bronchitis, which shows in CT scans as thickened airway walls.…”

Section: Discussionmentioning

confidence: 99%

“…It is believed that this shape is a result of remodelling and fixation of the tracheal cartilage induced by chronic coughing and inflammation. 4,25 These are very typical symptoms in COPD patients suffering from chronic bronchitis, which shows in CT scans as thickened airway walls. We also analyzed the relation of TI with GOLD stages (data shown in Appendix D), and we found that TI values for GOLD 1-4 were significantly smaller than for GOLD 0.…”

Section: A Trachea Analysismentioning

confidence: 99%

Computed tomography quantification of tracheal abnormalities in COPD and their influence on airflow limitation

et al. 2017

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Purpose To present a method to automatically quantify tracheal morphology changes during breathing and investigate its contribution to airflow impairment when adding CT measures of emphysema, airway wall thickness, air trapping and ventilation. Methods Because tracheal abnormalities often occur localized, a method is presented that automatically determines the most abnormal trachea section based on automatically computed sagittal and coronal lengths. In this most abnormal section, trachea morphology is encoded using four equiangular rays from the center of the trachea and the normalized lengths of these rays are used as features in a classification scheme. Consequently, trachea measurements are used as input for classification into GOLD stages in addition to emphysema, air trapping and ventilation. A database of 200 subjects distributed across all GOLD stages is used to evaluate the classification with a k nearest neighbour algorithm. Performance is assessed in two experimental settings: a) when only inspiratory scans are taken; b) when both inspiratory and expiratory scans are available. Results Given only an inspiratory CT scan, measuring tracheal shape provides complementary information only to emphysema measurements. The best performing set in the inspiratory setting was a combination of emphysema and bronchial measurements. The best performing feature set in the inspiratory-expiratory setting includes measurements of emphysema, ventilation, air trapping, and trachea. Inspiratory and inspiratory-expiratory settings showed similar performance. Conclusions The fully automated system presented in this study provides information on trachea shape at inspiratory and expiratory CT. Addition of tracheal morphology features improves the ability of emphysema and air trapping CT-derived measurements to classify COPD patients into GOLD stages and may be relevant when investigating different aspects of COPD.

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“…This malformation is commonly associated with COPD, emphysema, chronic bronchitis and bronchiolitis obliterans syndrome after lung transplantation [15,16]. It is believed that in COPD patients recurrent coughing and elevated intrathoracic pressure cause tracheal injures repeatedly.…”

Section: Discussionmentioning

confidence: 99%

Saber-sheath trachea as a challenge for safe surgery: A case report

et al. 2019

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Introduction. Saber-sheath trachea is a rare malformation of the trachea marked with coronal narrowing with concomitant widening of sagittal diameter, with a sagittal-to-coronal diameter ratio exceeding 2:1. As tracheal rings are stiff and do not collapse around the tube, the intubation is difficult. Case Report. A 53-year-old female was referred to our hospital due to failed intubation at the local hospital during a planned surgery of skin melanoma. The patient was scheduled for surgery in our hospital, her case was presented to a panel of anesthesiologists and she was prepared for surgery. The intubation failed again, even though a video-assisted laryngoscope and endotracheal tube with 5 mm internal diameter was used. The anesthesiologist noticed that the endotracheal tube entered the trachea only 2 cm due to strong resistance, so further intubation was not an option in order to avoid damaging the trachea. The surgery was performed in local anesthesia with analgosedation. Later on, computed tomography was done, because of suspected pathological process compressing trachea, but the radiologist described the anomaly as saber-sheath trachea. One year later, the patient presented with axillary lymph node metastases and needed another surgery. This time the anesthesiologist knew about the trachea malformation, anticipated difficult intubation and used i-gel TM for airway management. Conclusion. Despite the fact that numerous methods have been developed for the purpose of identifying patients at risk of difficult intubation, there are many unexpected airway pathologies that can lead to failed intubation. Adequate preoperative assessment, knowledge of Guidelines for Difficult Intubation Management, availability of supraglottic airway devices, and cooperation between the surgeon and anesthesiologist, are crucial to successful patient management.

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Saber-sheath trachea in a patient with bronchiolitis obliterans syndrome after lung transplantation

Cited by 5 publications

References 8 publications

Saber-sheath trachea in a patient with severe COPD

Saber-sheath trachea in a patient with severe COPD

Computed tomography quantification of tracheal abnormalities in COPD and their influence on airflow limitation

Saber-sheath trachea as a challenge for safe surgery: A case report

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