The Respiratory Tract
Airways may be affected by a variety of diseases. Diseases of the large airways can result from abnormalities of the wall (intrinsic abnormalities) or from compression from adjacent structures (extrinsic abnormalities). Intrinsic abnormalities are classif
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10
Walter De Wever
Contents
Abstract
10.1 Anatomy of the Large Airways . . . . . . . . . . . . . 248 10.1.1 Normal Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . 248 10.1.2 Anatomical Variations and Abnormalities . . . . . . 248 10.2 Evaluation of Trachea and Bronchial Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2.1 Evaluation of the Trachea . . . . . . . . . . . . . . . . . . . 10.2.2 Evaluation of the Carina . . . . . . . . . . . . . . . . . . . . 10.2.3 Evaluation of the Bronchi . . . . . . . . . . . . . . . . . . .
250 250 252 253
10.3 Diseases of Trachea and Bronchial Structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3.1 Bronchiectasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3.2 Focal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.3.3 Diffuse Diseases . . . . . . . . . . . . . . . . . . . . . . . . . .
254 254 256 260
›› Airways may be affected by a variety of diseases.
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
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W. De Wever Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium e-mail: [email protected]
Diseases of the large airways can result from abnormalities of the wall (intrinsic abnormalities) or from compression from adjacent structures (extrinsic abnormalities). Intrinsic abnormalities are classified as either focal or diffuse, depending on the extent of involvement of the airways. The diffuse abnormalities are less common and usually benign, most of the time caused by autoimmune illnesses or multisystem disorders. Focal abnormalities include tumors, infections, granulomatous diseases, and iatrogenic disorders. Focal disease tends to produce decreased airway diameter. The diffuse diseases may be divided into those that increase the diameter and those that decrease the diameter of the airway. Plain chest radiography remains a convenient first-line investigation for any patient who presents with respiratory symptoms and signs. The air within the trachea and main bronchi gives good, inherent radiographic contrast. Wellpenetrated films may demonstrate tracheobronchial pathology: however, abnormalities of the major airways can easily be missed on radiographs. Computed Tomography (CT) has been shown to be superior to conventional radiography in the detection of abnormalities of the airways. The axial CT images are primarily used for diagnostic purposes. Two-dimensional and three-dimensional reformatted images offer a number of advantages, such as a better assessment of the craniocaudal extent of disease and the ability to detect subtle airway stenoses.
E.E. Coche et al. (eds.), Comparative Interpretation of CT and Standard Radiography of the Chest, Medical Radiology, DOI: 10.1007/978-3-540-79942-9_10, © Springer-Verlag Berlin Heidelberg 2011
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10.1 Anatomy of the Large Airways 10.1.1 Normal Anatomy The airways are divided into conducting airways and transitional airways.
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