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Longitudinal Follow-up of Patients With Tracheobronchomalacia After Undergoing Tracheobronchoplasty

Computed Tomography Findings and Clinical Correlation

Bezuidenhout, Abraham F. MD*; Boiselle, Phillip M. MD; Heidinger, Benedikt H. MD*; Alape, Daniel MD; Buitrago, Daniel H. MD; Majid, Adnan MD; Gangadharan, Sidhu P. MD; Litmanovich, Diana E. MD*

doi: 10.1097/RTI.0000000000000339
Original Research
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Purpose: The purpose of this study was to evaluate intermediate and long-term changes in expiratory tracheal collapsibility by computed tomography (CT) in patients with tracheobronchomalacia following surgical treatment with tracheobronchoplasty and to correlate CT findings with clinical findings.

Materials and Methods: Between 2003 and 2016, 18 patients with tracheobronchomalacia underwent tracheobronchoplasty and were imaged preoperatively and postoperatively at both intermediate and long-term intervals. Imaging included end-inspiratory and dynamic expiratory phase scans. The cross-sectional area of the airway lumen was measured at 2 standard levels (1 cm above the aortic arch and carina). These measurements were used to calculate % collapsibility. Clinical findings recorded included a questionnaire on symptomatology and a 6-minute walk test.

Results: Before surgery, expiratory collapsibility of the upper trachea was 72%±25% (mean±SD) and that of the lower trachea was 68%±22%. On intermediate follow-up (mean, 1.5 y), collapsibility significantly decreased to 37%±21% at the upper trachea and 35%±19% at the lower trachea (P<0.001). On long-term follow-up (mean, 6 y), collapsibility increased to 51%±20% at the upper trachea and 47%±17% at the lower trachea and was significantly worse than on intermediate follow-up (P=0.002). However, collapsibility on long-term follow-up remained significantly lower than preoperative collapsibility (P=0.015). Clinical findings showed a similar trend as quantitative CT measurements.

Conclusion: Expiratory tracheal collapsibility substantially decreases after tracheobronchoplasty on intermediate follow-up. At long-term follow-up, tracheal collapsibility shows a modest increase, but remains significantly lower than the preoperative baseline. Quantitative measurements from dynamic CT have the potential to play an important role as imaging biomarkers for assessing response to tracheobronchoplasty.

*Department of Radiology

Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL

The authors declare no conflicts of interest.

Correspondence to: Abraham F. Bezuidenhout, MD, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215 (e-mail: abezuide@bidmc.harvard.edu).

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