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

Treatment

• 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. 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