Learning Radiology xray montage

Tracheal Stenosis

General Considerations

  • Ulceration of the mucosa and inflammation with granulation tissue formation produce the stenosis
  • Most occur at the site of the cuff, next most at the site of the stoma (in a tracheostomy) and least at the site of the tip of the tube
  • Causes include
    • Trauma, as in prolonged endotracheal intubation
    • Inflammatory disease like sarcoid and polychondritis
    • Neoplasm
    • Collagen vascular disease

Clinical Findings

  • Dyspnea

Imaging Findings

  • Conventional AP and lateral views are often obtained preliminarily
  • CT will demonstrate the lesion, especially on coronal reconstructions
    • The tracheal wall is normally 1-2 mm thick
  • Concentric or eccentric narrowing of the trachea, usually 1.5 to 2.5 cm in length
  • Granulation soft tissue will be seen internal to the cartilaginous structures
  • Cotton-Myer Classification system




Grade I

No obstruction

50% obstruction

Grade II

51% obstruction

70% obstruction

Grade III

71% obstruction

99% obstruction

Grade IV

No detectable lumen



  • Use of low-pressure cuffs has almost eliminated prolonged intubation as a cause
  • Treatment could include long-term tracheostomy, long-term intraluminal stent or surgical repair, either externally or endoscopically

 tracheal stenosis

 Tracheal Stenosis. Coronal and sagittal MPR images demonstrate marked narrowing of the trachea at point A and slightly less narrow extending to point B. The patient had a history of long-term endotracheal use.



Tracheal Stenosis after Tracheostomy or Intubation: Review with Special Regard to Cause and Management. A Sarper,  A Ayten, I Eser, O Ozbudak, and A Demircan. Tex Heart Inst J. 2005; 32(2): 154–158.


Using CT to Diagnose Nonneoplastic Tracheal Abnormalities Appearance of the Tracheal Wall. EM Webb, BM Elicker and WR Webb. May 2000, Volume 174, Number 5