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doi:10.1378/chest.06-2164
(Chest. 2007; 131:758-764)
© 2007 American College of Chest Physicians
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Comparison of Dynamic Expiratory CT With Bronchoscopy for Diagnosing Airway Malacia*

A Pilot Evaluation

Karen S. Lee, MD; Maryellen R. M. Sun, MD; Armin Ernst, MD, FCCP; David Feller-Kopman, MD, FCCP; Adnan Majid, MD and Phillip M. Boiselle, MD, FCCP

* From the Center for Airway Imaging, Department of Radiology, and Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Boston, MA.

Correspondence to: Armin Ernst, MD, FCCP, Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: aernst{at}bidmc.harvard.edu

Abstract

Objective: To assess the accuracy of dynamic expiratory CT for detecting airway malacia using bronchoscopy as the diagnostic "gold standard."

Materials and methods: A computerized hospital information system was used to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at our institution during a 19-month period. CT was performed within 1 week of bronchoscopy. All patients were scanned with a standard protocol, including end-inspiratory and dynamic expiratory volumetric imaging, using an eight-detector multislice helical CT scanner. For both CT and bronchoscopy, malacia was defined as ≥ 50% expiratory reduction of the airway lumen. CT and bronchoscopic findings were subsequently jointly reviewed by the radiologist and bronchoscopist for concordance.

Results: Twenty-nine patients (12 men and 17 women; mean age, 60 years; range, 36 to 79 years) comprised the study cohort. CT correctly diagnosed malacia in 28 of 29 patients (97%). The most common presenting symptoms were dyspnea in 20 patients (69%), severe or persistent cough in 16 patients (55%), and recurrent infection in 7 patients (24%). The estimated radiation dose (expressed as dose-length product) for the dual-phase study is 508 mGy-cm, which is comparable to a routine chest CT.

Conclusion: Dynamic expiratory CT is a highly sensitive method for detecting airway malacia and has the potential to serve as an effective, noninvasive test for diagnosing this condition.

Key Words: airway • bronchomalacia • CT • malacia • tracheobronchomalacia • tracheomalacia




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A. Majid, J. Guerrero, S. Gangadharan, D. Feller-Kopman, P. Boiselle, M. DeCamp, S. Ashiku, G. Michaud, F. Herth, and A. Ernst
Tracheobronchoplasty for Severe Tracheobronchomalacia: A Prospective Outcome Analysis
Chest, October 1, 2008; 134(4): 801 - 807.
[Abstract] [Full Text] [PDF]


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