World Congress Thoracic Imaging June 18-21, 2017, Hynes Convention Center, Boston, Massachusetts June 18-21, 2017, Hynes Convention Center, Boston, Massachusetts

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Fleischner Society Society of Thoracic Radiology European Society of Thoracic Imaging Japanese Society of Thoracic Radiology Korean Society of Thoracic Radiology
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Longitudinal Follow-Up ofPatients with Tracheobronchomalacia after Undergoing Tracheobronchoplasty -MDCT Findings and Clinical Correlation
Abraham F Bezuidenhout, Phillip M Boiselle, Alexander A Bankier, Benedikt H Heidinger, Daniel Alape, Daniel H Buitrago, Adnan Majid, Sidharta P Gangadharan, Diana E Litmanovich
Beth Israel Deaconess Medical Center, Boston, MA

Purpose: To describe the long-term MDCT follow-up of patients with excessive dynamic airway collapse (EDAC) following tracheobronchoplasty and to correlate MDCT findings with qualitative outcomes. Materials and Methods: Between November 2003 and October 2016, 18 patients (mean age 6512 years; 72% females) with a bronchoscopically-confirmed diagnosis of EDAC underwent tracheobronchoplasty at our institution. Patients were imaged using the same MDCT protocol preoperatively and postoperatively at both intermediate (1-2 yr) and long term (≥ 5yr) intervals. The MDCT protocol included imaging during two phases of respiration: end-inspiratory and dynamic expiratory phases. Using a previously validated technique, the cross-sectional area (CSA) of the airway lumen was measured with an electronic tracing tool at 2 standard levels (1 cm above the aortic arch and 1 cm above the carina). These measurements were used to calculate % collapsibility. Results: Before surgery, collapsibility of the upper trachea was 72%25% and of the lower trachea was 68%22%. On intermediate follow-up (mean 1.5 years), 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 (average of 6 years), collapsibility increased to 51%20% at the upper trachea and 47%17% at the lower trachea, significantly worse than on the intermediate follow-up study (p= 0.002). However, collapsibility on long-term follow-up remained significantly lower than pre-operative collapsibility at the upper and lower trachea (p=0.015). On intermediate follow-up 14/18 (78%) patients reported improvement of symptoms, while on long-term follow up 11/18 (61%) patients reported continued improvement of symptoms. Conclusions: Expiratory tracheal collapsibility substantially decreases after tracheobronchoplasty on intermediate follow-up. Tracheal collapsibility shows a modest increase in severity at long-term follow-up, but remains significantly lower than the pre-operative baseline.


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