Tracheobronchomalacia in the Adult: Is Imaging Helpful?

Abstract

The aim of this article is to: 1) Review the imaging features of tracheobronchomalacia and excessive dynamic airway collapse 2) To highlight the recent advances in imaging of the central airways. Imaging of the central airways requires dedicated techniques optimized to evaluate the transient collapse of the central airways either due to excessive movement of the posterior membrane and/or secondary to weakness of the tracheal cartilages. Routine imaging of the chest is limited in its ability to demonstrate the true extent of collapsibility of the airways. The more recently introduced imaging protocols utilize dynamic acquisition during active expiration which demonstrate the transient but true extent of the airway collapse. CT also has potential applications in treatment in the form of 3D-printed splints. Dedicated imaging protocols introduced with recent advances in CT technology allow diagnosis of tracheobronchomalacia (TBM) noninvasively. However, there is a current lack of clear threshold for diagnosis which has led to a wide range of reported prevalence of TBM and excessive dynamic airway collapse.