Trakeal stenoz

Özet

Edinilmiş trakeal stenoz en sık entübasyon veya trakeostomi sonrası gelişen skar daralmasıdır; geçirilmiş hava yolu girişimi öyküsü tanısal aramayı yönlendirir. BT, darlığın yerini ve kraniokaudal uzanımını, ayrıca komşu mediastinal yapılarla ilişkisini değerlendirmeye yardımcı olur. Trakeal darlığın şiddetine bağlı olarak dispne veya stridor görülebilir; BT ile darlığın nedeni ve yaygınlığı değerlendirilmelidir. Lezyon gözden kaçarsa ilerleyici santral hava yolu obstrüksiyonu ve distal sekresyon birikimi yanlışlıkla astım veya tekrarlayan enfeksiyon olarak yorumlanabilir.

Okuma sırası

1. Trakea ve girişim izleri. MPR görüntülerini, trakeal stenozun tanısal değerlendirmesi ve tedavi planlaması için incele.
2. En dar trakeal lümen. En dar noktayı trakea eksenine dik aksiyel kesitte çevrele; kesit alanını sağlam komşu lümenle karşılaştır.
3. Stenotik segment. Koronal düzlemde skar halkasının üst ve alt sınırlarını takip ederek stenotik segmentin uzunluğunu ölç.
4. Distal trakeobronşiyal ağaç. Trakeobronşiyal ağaçta mukus tıkacı ve eşlik eden atelektaziyi değerlendir.

Faz ve pencere

Kontrastsız tanısal

İnce kesitli helikal BT ve çok düzlemli reformasyonlar, stenozun yerini, uzunluğunu, en dar lümenini ve komşu yapılarla ilişkisini değerlendirmeye yardımcı olur. Sekresyonlar ve hareket ölçümü etkileyebilir.

BT bulguları

• Uzamış entübasyon ve trakeostomi edinilmiş trakeal stenoz nedenleri arasındadır; entübasyonla ilişkili yüksek manşon basıncı mukozal hasara ve ardından stenoz gelişimine yol açabilir.
• Trakeostomi açıklığında granülasyon dokusu ve fibrozise bağlı daralma izlenebilir.
• Aksiyel kesitte dar lümenin alanı ve iki dik çapı; komşu normal trakea ile kıyaslanır
• Koronal ve sagittal reformasyonlarda darlığın üst-alt sınırları ve toplam uzunluğu
• İdiyopatik subglottik stenozda kıkırdak halkalar genellikle histolojik olarak normaldir.
• Darlık distalinde mukus tıkacı görülebilir; tıkanıklık distal akciğer kollapsına yol açabilir.
• İnfiltratif yumuşak doku bileşeni, dıştan bası veya eşlik eden fistül olasılığı
• Raporlamada stenozun yerini, kraniokaudal uzanımını, şiddetini ve morfolojisini; mümkünse en dar lümen çapı veya alanını ve komşu yapılarla ilişkisini belirtin.

Ölçütler ve sınıflamalar

Lümen alanı azalması için stenoz eşiği

>%50

Myer-Cotton

Olgun, sıkı subglottik darlıkta lümen alanı azalması: derece I %0–50, II %51–70, III %71–99, IV saptanabilir lümen yok. Trakeal skarın uzunluğunu veya karmaşık morfolojisini tek başına tanımlamaz.

Normalde

Trakeal stenoz için tanı ölçütü, hava yolu lümeninin kesit alanında %50’den fazla azalmadır. Myer–Cotton derecelendirmesi subglottik stenoz için geliştirilmiştir; trakeal stenozda uzunluk ve morfoloji ayrıca belirtilmelidir.

Ayırıcı tanı

Trakeal tümörler, trakeal stenozun olası nedenleri arasındadır.

Trakeobronkomalazi

inspirasyon-ekspirasyon arasında değişen lümen çökmesi

Dıştan bası

lümen eksantrik itilmiş, komşu kitle veya damar genişlemiş

Trakeobronşiyal amiloidozda BT'de çevresel ve düzensiz duvar kalınlaşması, kalsifikasyon ve nodüler mukozal çıkıntılar görülebilir.

Trakeobronşiyal mukus tıkacı BT'de lümen içinde şerit biçimli, yüksek dansiteli içerik olarak görülebilir.

Tuzaklar

• Eğik aksiyel kesit lümeni olduğundan küçük gösterir; trakea merkez hattına dik multiplanar kesitte doğrula.
• Mukus sekresyonu kısa darlık gibi görünebilir; seri kesitlerde şekil değişimini ve duvarla bağlantısını izle.
• Trakeostomi sonrası stenoz gelişebileceğinden, trakeostomi öyküsünü trakeal darlığı değerlendirirken dikkate al.
• İnspirasyon BT'si eşlik eden fokal malaziyi dışlamaz; klinik şüphede dinamik inceleme gerekir.

Kendini dene

1. Uzamış endotrakeal entübasyon sonrasında gelişen trakeal stenoz için kaynakta belirtilen yaygın neden hangisidir?

   • Postentübasyon trakeal stenoz
   • Konjenital trakeal halka anomalisi
   • Vasküler halka basısı
   • İdiyopatik subglottik stenoz
   Cevabı göster

   Postentübasyon trakeal stenoz. Trakeal stenoz, uzamış endotrakeal entübasyon sonrasında sık görülen bir komplikasyondur.

2. Helikal BT’nin aksiyel BT’ye göre trakeal stenoz değerlendirmesindeki avantajlarından biri hangisidir?

   • Darlığın kraniokaudal uzanımını değerlendirmek
   • Yalnız gecikmiş faz görüntüleme sağlamak
   • Yalnız kemik penceresinde görüntüleme yapmak
   • Darlığın nedenini tek başına kesinleştirmek
   Cevabı göster

   Darlığın kraniokaudal uzanımını değerlendirmek. Helikal BT, darlığın kraniokaudal uzanımını değerlendirmede aksiyel BT’ye göre avantaj sağlayabilir.

İlgili konular

• Trakeal tümör ve endoluminal kitle
• Trakeobronkomalazi

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. A review on diagnostic assessments of tracheal stenosispmc.ncbi.nlm.nih.gov
2. Idiopathic subglottic stenosis: a reviewpmc.ncbi.nlm.nih.gov
3. Vascular rings.pubmed.ncbi.nlm.nih.gov
4. Congenital tracheobronchial stenosis.pubmed.ncbi.nlm.nih.gov
5. Pediatric airway surgery.pubmed.ncbi.nlm.nih.gov
6. Imaging of the trachea.pubmed.ncbi.nlm.nih.gov
7. Recent advances in optical coherence tomography for the diagnoses of lung disorders.pubmed.ncbi.nlm.nih.gov
8. Tracheobronchial involvement of relapsing polychondritis.pubmed.ncbi.nlm.nih.gov
9. Tracheobronchial stenosis: causes and advances in management.pubmed.ncbi.nlm.nih.gov
10. Multi-disciplinary management of patients with benign airway strictures: A review.pubmed.ncbi.nlm.nih.gov
11. Computed tomography correlation of airway disease with bronchoscopy: part I--nonneoplastic large airway diseases.pubmed.ncbi.nlm.nih.gov
12. Tracheal anomalies associated with Down syndrome: A systematic review.pubmed.ncbi.nlm.nih.gov
13. Multidetector CT evaluation of airway stents: what the radiologist should know.pubmed.ncbi.nlm.nih.gov
14. [Idiopathic Subglottic Tracheal Stenosis].pubmed.ncbi.nlm.nih.gov
15. Correlations of Radiographic and Endoscopic Observations in Subglottic Stenosis.pubmed.ncbi.nlm.nih.gov
16. Flexible CO2 Laser Treatment for Subglottic Stenosis.pubmed.ncbi.nlm.nih.gov
17. Laryngotracheal Stenosis: Our Experience in a Tertiary Care Hospital.pubmed.ncbi.nlm.nih.gov
18. Localised laryngotracheal amyloidosis: a differential diagnosis not to forget.pubmed.ncbi.nlm.nih.gov
19. Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography.pubmed.ncbi.nlm.nih.gov
20. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings.pubmed.ncbi.nlm.nih.gov
21. The forgotten airway: central airway pathology in the ICU.pubmed.ncbi.nlm.nih.gov
22. CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay.pubmed.ncbi.nlm.nih.gov
23. Multidimensional evaluation of tracheobronchial disease in adults.pubmed.ncbi.nlm.nih.gov
24. Identification of imaging-based pulmonary and extrapulmonary treatable traits in COPD: a review.pubmed.ncbi.nlm.nih.gov
25. A review on diagnostic assessments of tracheal stenosis.pubmed.ncbi.nlm.nih.gov
26. Endoscopic Preoperative Assessment, Classification of Stenosis, Decision-Making.pubmed.ncbi.nlm.nih.gov
27. Silent Post-intubation Tracheal Stenosis Unmasked by Status Epilepticus in a Paediatric Neurotrauma Survivor: A Triple Jeopardy Airway Crisis.pubmed.ncbi.nlm.nih.gov
28. Tracheal mucosal necrosis and sloughing after accidental endotracheal extubation in a child: a case report and literature review.pubmed.ncbi.nlm.nih.gov
29. CT Imaging Features of Pulmonary Sarcoidosis: Typical and Atypical Radiological Features and Their Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
30. Autoimmune disease of head and neck, imaging, and clinical review.pubmed.ncbi.nlm.nih.gov
31. Focus on Rare Tracheal Pathologies You Should Not Miss.pubmed.ncbi.nlm.nih.gov
32. Diagnosis and treatment strategies for airway involvement in relapsing polychondritis: a comprehensive review.pubmed.ncbi.nlm.nih.gov
33. Relapsing polychondritis with isolated tracheal involvement: Imaging findings on CT, MRI, and PET-CT: A case report and literature review.pubmed.ncbi.nlm.nih.gov
34. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
35. Does laparoscopic surgery decrease the risk of atrial fibrillation after foregut surgery?pubmed.ncbi.nlm.nih.gov
36. Airway stenosis: classification, pathogenesis, and clinical management.pubmed.ncbi.nlm.nih.gov
37. Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children.pubmed.ncbi.nlm.nih.gov
38. Airway Ultrasound: Applications in Pediatric Anesthesiology and Critical Care.pubmed.ncbi.nlm.nih.gov
39. Anesthetic management of giant thyroid tumor with cardiac comorbidity causing tracheal compression: a case report.pubmed.ncbi.nlm.nih.gov
40. Tracheal stenosis as a complication of prolonged intubation in coronavirus disease 2019 (COVID-19) patients: a Peruvian cohort.pubmed.ncbi.nlm.nih.gov
41. A syndrome of severe idiopathic pulmonary parenchymal disease with pulmonary hypertension in Pekingese.pubmed.ncbi.nlm.nih.gov
42. Prevalence of Central Airway Anatomical Variations and Structural Abnormalities Using Virtual Bronchoscopy: A Retrospective Study From a Tertiary Care Center.pubmed.ncbi.nlm.nih.gov
43. Anesthetic Management of Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis Involving a Sequential Airway Strategy.pubmed.ncbi.nlm.nih.gov
44. Airway Management Using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange for Critical Distal Tracheal Stenosis Caused by a Massive Goiter: A Case Report.pubmed.ncbi.nlm.nih.gov
45. Animal models of benign airway stenosis: Advances in construction techniques, evaluation systems, and perspectives.pubmed.ncbi.nlm.nih.gov
46. Unveiling the clinical and proteomic spectrum of relapsing polychondritis with respiratory involvement.pubmed.ncbi.nlm.nih.gov
47. Pediatric Congenital Tracheobronchial Variants and Their Clinical Significance for Endotracheal Intubation and Airway Management: A Scoping Review of Fetal, Neonatal, and Pediatric Cases.pubmed.ncbi.nlm.nih.gov
48. Small airway disease as a key factor in COPD: new perspectives and insights.pubmed.ncbi.nlm.nih.gov
49. Inflammatory myofibroblastic tumors in children: a single-center retrospective study of clinical features, management, and outcomes.pubmed.ncbi.nlm.nih.gov
50. Incidental Findings in Lung Cancer Screening.pubmed.ncbi.nlm.nih.gov
51. Small Airway Disease in Pre-COPD and Early COPD: Insights Into the Pulmonary "Silent Zone".pubmed.ncbi.nlm.nih.gov
52. Eosinophil Extracellular Traps in Health and Disease: From Host Defense to Chronic Inflammation.pubmed.ncbi.nlm.nih.gov
53. Towards a bioengineered airway: advances in tracheal tissue engineering and biofabrication.pubmed.ncbi.nlm.nih.gov
54. How to do it: the difficult thyroid.pubmed.ncbi.nlm.nih.gov
55. Treatment of post-resuscitation cicatricial tracheal stenosis after suffering severe COVID-19 associated pneumonia: A report of 11 cases.pubmed.ncbi.nlm.nih.gov
56. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience.pubmed.ncbi.nlm.nih.gov
57. Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus.pubmed.ncbi.nlm.nih.gov
58. Anesthetic Management of a Patient With Post-Intubation Tracheal Stenosis: Use of V-V ECMO.pubmed.ncbi.nlm.nih.gov
59. Tracheobronchomegaly associated with tracheobronchopathia osteochondroplastica: a case report.pubmed.ncbi.nlm.nih.gov
60. Tracheobronchial Amyloidosis Accompanied with Asthma: A Case Report and a Mini-Review.pubmed.ncbi.nlm.nih.gov
61. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
62. Expanding applications of 3D-Printed stents to non-stenotic airways.pubmed.ncbi.nlm.nih.gov
63. Recent advances in artificial intelligence across interventional pulmonology: a narrative review.pubmed.ncbi.nlm.nih.gov
64. Forbearance with endobronchial stenting: cognisance before conviction.pubmed.ncbi.nlm.nih.gov
65. The single-cell transcriptional landscape of the pediatric cystic fibrosis lung from minimally invasive respiratory specimens.pubmed.ncbi.nlm.nih.gov
66. Case Report: Awake lateral decubitus intubation for a patient with critical tracheal stenosis secondary to retrosternal goiter: salvaging a 2 mm airway without ECMO support.pubmed.ncbi.nlm.nih.gov
67. Preliminary investigation of the clinical value of thoracic ultrasound in pediatric pleuropulmonary blastoma: a comparative analysis with computed tomography and pathology.pubmed.ncbi.nlm.nih.gov
68. 3D printing as an innovative tool in personalized management of complex airway diseases: a literature review.pubmed.ncbi.nlm.nih.gov
69. Task-Oriented Biomedical Microrobots: Access, Working Environment, Actuation, Body Design, Detection and Control.pubmed.ncbi.nlm.nih.gov
70. Epstein-Barr virus-associated inflammatory polyp of the proximal cervical trachea causing central airway obstruction: a case report.pubmed.ncbi.nlm.nih.gov
71. Case Series of Incidentally Found Chronic Airway Foreign Bodies: A Single-Center Experience.pubmed.ncbi.nlm.nih.gov
72. Transbronchoscopic cryotherapy for a giant sputum plug straddling the tracheal carina: A case report.pubmed.ncbi.nlm.nih.gov
73. Pneumomediastinum With Mediastinitis Following Third Molar Extraction With a High-Speed Air Handpiece: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
74. Partial cricotracheal resection for treatment of subglottic stenosis: complications and outcomes.pubmed.ncbi.nlm.nih.gov
75. Obstructive fibrinous tracheal pseudomembrane complicated with bronchial mucus plug: A rare post-intubation complication case report.pubmed.ncbi.nlm.nih.gov
76. Etiology-based management spectrum and outcomes of pediatric central airway stenosis: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
77. Single-center experience with aortopexy in pediatric tracheomalacia: a case series.pubmed.ncbi.nlm.nih.gov
78. Anatomic reference measures for central airway anatomy in Indian adults: implications for precision airway management in surgical patient safety.pubmed.ncbi.nlm.nih.gov
79. Association Between Airway Stenosis Degree and Respiratory Distress in Infants With a Vascular Ring.pubmed.ncbi.nlm.nih.gov
80. Research progress in the application of double-lumen endobronchial tubes and bronchial blockers in thoracic surgery.pubmed.ncbi.nlm.nih.gov
81. Benign subglottic stenosis from a rheumatologist' perspective: a narrative review.pubmed.ncbi.nlm.nih.gov
82. Cardiothoracic manifestations of neuroendocrine tumours.pubmed.ncbi.nlm.nih.gov
83. Surgical outcome and perioperative management of tracheal resection and reconstruction for patients with a primary tracheal tumor.pubmed.ncbi.nlm.nih.gov
84. Advances in Pharmacological Therapy of Benign Tracheal Stenosis: A Meta-Analysis of Preclinical Studies.pubmed.ncbi.nlm.nih.gov
85. Tracheobronchial amyloidosis in a 64-year-old woman with type 2 diabetes mellitus and Sjögren's syndrome: a case report.pubmed.ncbi.nlm.nih.gov
86. Solitary nodular pulmonary amyloidosis mimicking primary lung cancer: A case report.pubmed.ncbi.nlm.nih.gov
87. Pulmonary Aspergillosis: What CT can Offer Before it is too Late!pubmed.ncbi.nlm.nih.gov
88. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Nonproliferative and Proliferative Lesions of the Rabbit.pubmed.ncbi.nlm.nih.gov
89. Tracheal Stenting with Dumon Stent - A Novel Treatment Modality for Tracheal Stenosis.pubmed.ncbi.nlm.nih.gov
90. Inferiorly Based Björk Flap and Accidental Decannulation in Surgical Tracheostomy: A Single-Institution Cohort Study and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
91. Perioperative outcome and predictors of success after tracheal resection.pubmed.ncbi.nlm.nih.gov
92. CT-guided three-dimensional reconstruction with predictive modeling for personalized esophageal anastomosis in type C esophageal atresia.pubmed.ncbi.nlm.nih.gov
93. The mineralised epiglottis: a narrative review illustrated by an index case.pubmed.ncbi.nlm.nih.gov
94. Life-Threatening Acute Hypoxemic Respiratory Failure Caused by Complete Left Lung Collapse Secondary to Mucus Plug Obstruction in a Toddler: A Case Report.pubmed.ncbi.nlm.nih.gov
95. Primary Tracheobronchial Low-Grade Mucoepidermoid Carcinoma: A Report of a Rare Case.pubmed.ncbi.nlm.nih.gov
96. Cardiovascular Computed Tomography Angiographic Assessment of Simple Cardiac Shunts in Adults.pubmed.ncbi.nlm.nih.gov
97. Clinical TNM Lung Cancer Staging: A Diagnostic Algorithm with a Pictorial Review.pubmed.ncbi.nlm.nih.gov
98. Multi-detector computed tomography imaging of large airway pathology: A pictorial review.pubmed.ncbi.nlm.nih.gov
99. Computed tomography angiography-guided conservative management of a penetrating ballistic neck injury involving the carotid sheath: A case report.pubmed.ncbi.nlm.nih.gov
100. A Case of Complicated Traumatic Generalized Surgical Emphysema, Pneumomediastinum, Pneumopericardium, Pneumothorax, and Pneumoperitoneum Due to Accidental Dislodgement of Tracheostomy Tube.pubmed.ncbi.nlm.nih.gov
101. Mediastinal tracheostomy: techniques, outcomes and quality of life-a systematic review.pubmed.ncbi.nlm.nih.gov
102. Case Report: Management of suprastomal granulomas and severe glottic edema after tracheostomy using suspension laryngoscopy and bronchoscopy.pubmed.ncbi.nlm.nih.gov
103. Application of modified endotracheal tube in nursing of retracted stoma with severe moisture-associated skin damage: A case report.pubmed.ncbi.nlm.nih.gov
104. Case Report: Awake double-lumen tube intubation and intraoperative ventilation strategy conversion in an obese adolescent with a giant anterior mediastinal teratoma.pubmed.ncbi.nlm.nih.gov
105. Use of a Biologically Transparent Illumination Guide during Secondary Thoracoscopic Posterior Tracheopexy for Severe Tracheomalacia after Esophageal Atresia Repair: A Case Report.pubmed.ncbi.nlm.nih.gov
106. Clinical study of bronchial wall area proportion in children and adolescents based on CT images.pubmed.ncbi.nlm.nih.gov
107. Progressive Extension of a Post-intubation Tracheal Laceration Presenting As Massive Pneumomediastinum: A Case Report.pubmed.ncbi.nlm.nih.gov
108. Quantitative CT measurements of segmental bronchial changes during inspiratory and expiratory phases in healthy subjects.pubmed.ncbi.nlm.nih.gov
109. Low-Dose Whole-Chest Dynamic CT for the Assessment of Large Airway Collapsibility in Patients with Suspected Tracheobronchial Instability.pubmed.ncbi.nlm.nih.gov
110. Recurrent Pediatric Upper Tracheal Stenosis Stabilized with a Montgomery Airway Stent: A Case Report.pubmed.ncbi.nlm.nih.gov
111. Management of benign tracheal stenosis: rigid bronchoscopy versus serial cannulas-a retrospective cohort study from a tertiary center.pubmed.ncbi.nlm.nih.gov
112. Diagnostic accuracy of non-invasive modalities for laryngotracheal stenosis: A systematic review and meta-Analysis.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.