Tracheal Stenosis due to Injury

by Janice Cook-Granroth, Susanne Shamsolkottabi, Geoffrey McLennan, M.D. and Scott Graham, M.D.


Index:

Patinet History
MPEG Movies
Airway Measurements

April 1995
July 1999
August 1999
November 2000
February 2001
Summary

Patient History

The subject is a 65 year old male who has recurrent tracheal stenosis following a traumatic tracheal injury 7 years ago.

He normally has carbon dioxide laser treatments every 6 to 12 weeks. On this occasion following his carbon dioxide laser treatment, a Dumon Silicon trachea stent was placed distal to his tracheostomy tube (5cm x 14 mm).

The stent appeared to be in a good position. Seven days after the stent placement re-examination showed that the stent had shifted distally in the trachea.

Access to his trachea is only possible via a small tracheostomy stoma, and it was not possible to place a larger stent.

The initial stent was removed.Subsequently the patient has had further laser procedures (CO2 and Nd:YAG)and most recently a successful balloon tracheoplasty.


MPEG Movies


from April 1995.


from Aug. 1999.


from Nov. 2000


from Feb. 2001


Original Electron Beam CT

The original trans axial section Cine CT data set of tracheal stenosis. This scan was done before the patient's surgery to have a stent placed in his trachea. The images are 3 mm thick.

This scan was a follow up to the stent placement, scan taken in July 1999. There are 172 slices at 3mm intervals with 1.5mm overlap.
This scan was a follow up to the stent placement, scan taken in August 1999. There are 139 slices at 3mm intervals with 1.5mm overlap.
This scan was taken on the Aquilion scanner in Feb. 2001. There are 252 slices at 1mm intervals with 0.5mm overlap.

Surface Rendering of Trachea

3D Movie of Trachea from the 1995 scan.

3D Movie of Trachea from the July 1999 scan. The airway is yellow, the tracheostomy tube is brownish, and the stent is blue.The patient was moving quite a bit during the scan.
3D Movie of Trachea from the July 1999 scan. The airway is yellow, and the tracheostomy tube is brownish. The patient was moving quite a bit during the scan.
3D Movie of Trachea from the Aug 1999 scan. The airway is yellow, the tracheostomy tube is brownish, and the stent is blue.
3D Movie of Trachea from the Nov. 2000 scan. The airway is yellow, the tracheostomy tube is redish, and the stent is blue.
3D Movie of Trachea from the Nov. 2000 scan.
3D Movie of Trachea from the Feb. 2001 scan. The airway is yellow, the tracheostomy tube is redish, and the stent is blue.
3D Movie of Trachea from the Feb. 2001 scan.

The bronchoscopic views.

Laser procedure.
Post laser view.

Reconstructed oblique images from original data set.

The images are made from the same program that calculates the trachea size just below the tracheal tube.(given below).
The images are made from the same program that calculates the trachea tube size (given below).

Maxium Intensity Projection views.

3D Movie of Trachea from the Feb. 2001 scan.


Measurements from April 1995.

Tube Geometry Analysis Summary
Date            : Thu Apirl 24 17:16:01 1995
Oblique slices  : 31
Segmented image : tga.seg
Original image  : tga.ori
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1     115.038  15.236   10.548  ( 86.32,108.94, 99.22)  15.236   8.532       8.926 
    2     100.272  14.064    9.962  ( 86.66,110.57,101.99)  14.650   6.859       7.248 
    3      86.879  14.064    9.962  ( 85.90,111.77,104.84)  14.685   7.032       7.862 
    4      63.185  10.548    9.962  ( 85.63,112.87,107.82)  11.543   6.446       7.081 
    5      55.287  11.134    9.376  ( 86.13,114.85,110.22)  11.119   5.528       6.681 
    6      53.226  10.548    9.962  ( 86.72,116.33,112.94)  11.272   4.577       4.724 
    7      57.004  11.720    8.790  ( 86.84,117.68,115.82)  11.676   5.528       5.559 
    8      67.306  12.306    9.962  ( 86.09,118.39,118.83)  12.905   5.771       5.860 
    9      83.445  12.892   11.720  ( 85.98,119.69,121.65)  14.556   6.118       6.681 
   10      84.475  12.306   11.720  ( 86.14,120.46,124.65)  14.306   6.311       6.681 
   11      86.536  11.720   12.892  ( 85.51,121.70,127.56)  14.790   5.860       5.860 
   12      87.223  10.548   12.306  ( 86.66,123.04,130.24)  14.173   7.081       7.343 
   13      83.789  10.548   12.306  ( 86.32,124.48,133.12)  13.668   6.859       7.343 
   14      93.404  11.134   12.892  ( 87.47,126.09,135.67)  13.491   7.641       7.970 
   15     103.706  11.720   13.478  ( 86.64,127.28,138.47)  14.697   8.287       8.652 
   16     112.634  12.892   13.478  ( 86.16,128.19,141.45)  15.482   8.390       9.753 
   17     114.007  12.306   12.892  ( 86.34,129.35,144.35)  14.790   8.945       9.753 
   18     114.694  11.720   14.064  ( 85.59,130.22,147.28)  15.020   9.449       9.467 
   19     131.521  12.892   15.236  ( 84.89,131.29,150.24)  16.250   9.979      10.483 
   20     142.853  12.892   16.408  ( 85.25,130.96,153.43)  17.851  10.367      11.010 
   21     144.226  12.306   16.994  ( 85.88,131.31,156.48)  17.794  10.384      10.564 
   22     142.509  11.720   16.994  ( 86.11,131.96,159.54)  17.976  10.014      10.014 
   23     143.540  11.134   17.580  ( 85.18,133.25,162.29)  18.194   9.962      10.384 
   24     155.558  11.134   18.166  ( 85.23,134.16,165.34)  18.761   9.665       9.665 
   25     171.355  12.306   19.338  ( 85.54,134.32,168.54)  20.206  10.031      10.564 
   26     172.041  11.720   19.924  ( 85.35,135.59,171.50)  19.480  10.613      10.947 
   27     176.162  11.720   20.510  ( 84.97,136.26,174.62)  20.342  10.014      10.234 
   28     178.223  11.720   20.510  ( 83.55,137.00,177.40)  20.232   9.449       9.539 
   29     188.868  12.306   20.510  ( 83.42,137.61,180.59)  20.718  10.564      10.693 
   30     202.947  12.306   21.096  ( 84.38,137.82,183.69)  20.543  11.119      11.149 
   31     258.577  14.064   25.784  ( 81.03,138.05,188.42)  25.744  10.251      10.805

The tracheal tube.


Tube Geometry Analysis Summary
Date            : Thu April 24 17:33:21 1995
Oblique slices  : 31
Note            : trachea tube only
Segmented image : tga.tube.seg
Original image  : tga.ori
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      24.376   5.273    5.859  ( 86.95,124.37, 38.00)   5.975   4.225       4.266 
    2      24.033   5.273    5.273  ( 86.78,126.15, 38.96)   5.559   4.225       5.402 
    3      24.033   5.273    4.688  ( 86.68,127.38, 40.32)   5.402   4.266       4.972 
    4      23.689   5.273    4.688  ( 86.81,128.74, 41.55)   5.402   4.462       4.832 
    5      21.973   4.688    5.273  ( 86.89,130.05, 42.83)   5.273   4.576       4.688 
    6      23.346   5.859    5.273  ( 86.81,131.55, 43.88)   5.975   4.225       4.832 
    7      25.749   5.273    4.688  ( 86.66,132.76, 45.26)   5.771   4.688       4.724 
    8      26.436   5.859    4.688  ( 86.74,134.19, 46.41)   5.975   4.688       4.832 
    9      23.689   5.859    5.273  ( 86.55,135.30, 47.89)   5.859   4.266       5.273 
   10      25.063   5.273    5.273  ( 86.48,136.84, 48.94)   5.559   4.576       5.559 
   11      24.376   5.273    4.688  ( 86.51,137.68, 50.59)   5.528   4.225       4.225 
   12      24.719   5.273    4.688  ( 86.63,138.78, 52.07)   5.402   4.576       4.972 
   13      25.063   5.273    5.273  ( 86.80,140.05, 53.43)   5.402   4.225       5.402 
   14      23.689   5.273    4.688  ( 86.62,141.44, 54.67)   5.402   4.576       4.832 
   15      25.749   5.859    4.688  ( 86.54,142.33, 56.31)   5.975   4.576       4.832 
   16      27.466   6.445    4.688  ( 86.49,142.90, 58.08)   6.551   4.576       4.832 
   17      27.809   5.859    4.688  ( 86.51,144.01, 59.58)   5.975   4.724       4.832 
   18      28.839   6.445    4.688  ( 86.52,144.59, 61.36)   6.551   4.688       4.832 
   19      27.466   6.445    4.688  ( 86.58,145.13, 63.16)   6.445   4.724       4.688 
   20      27.123   5.859    4.688  ( 86.75,146.29, 64.63)   5.975   4.724       4.832 
   21      21.629   5.273    4.688  ( 86.60,147.31, 66.29)   5.402   4.462       4.832 
   22      26.779   5.859    4.688  ( 86.74,147.22, 68.23)   5.975   4.462       4.724 
   23      31.929   6.445    5.273  ( 87.32,148.30, 69.70)   6.681   5.273       5.402 
   24      26.779   6.445    4.688  ( 87.14,149.07, 71.44)   6.551   4.462       4.832 
   25      30.899   6.445    5.273  ( 87.51,149.34, 73.35)   6.472   5.006       5.306 
   26      28.153   6.445    4.688  ( 86.77,150.16, 74.97)   6.445   4.724       4.688 
   27      25.406   5.859    4.688  ( 86.49,150.15, 76.82)   5.859   4.688       4.688 
   28      29.526   6.445    4.688  ( 86.45,150.59, 78.64)   6.551   4.724       4.724 
   29      24.033   5.273    4.688  ( 86.52,151.29, 80.44)   5.528   4.576       4.724 
   30      21.629   4.688    4.102  ( 86.78,151.76, 82.30)   5.528   4.102       4.225 
   31      26.093   5.273    4.688  ( 86.49,151.87, 84.27)   5.771   4.724       5.006

Measurements from July 1999.

Tube Geometry Analysis Summary
Date            : Tue Jul 13 14:26:09 1999
Oblique slices  : 15
Segmented image : seg.s35-133_int
Original image  : c071299
Note            : trachea from below the trach tube
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      14.954   5.469    3.418  (249.53,240.67,140.43)   5.880   0.967       0.967 
    2      32.244   8.203    4.102  (248.07,246.58,143.89)   8.565   4.158       4.586 
    3      34.580  10.254    4.102  (245.55,247.53,148.45)  10.612   2.819       2.819 
    4      44.394   8.203    8.203  (243.90,249.29,153.16)  10.634   3.867       4.377 
    5      21.496   5.469    6.152  (244.37,252.74,157.55)   7.038   2.465       2.465 
    6      40.655   6.836    7.520  (242.72,255.60,162.07)   8.754   4.834       5.339 
    7      32.711   6.152    6.152  (240.74,255.33,167.51)   7.794   4.586       4.834 
    8      48.132   7.520    8.887  (242.43,254.59,173.00)   9.667   4.977       5.800 
    9      17.290   6.152    4.785  (247.30,255.15,176.93)   5.511   3.057       3.057 
   10      13.552   4.102    4.102  (247.53,255.76,183.18)   4.586   2.734       3.681 
   11       9.346   3.418    3.418  (246.82,256.07,189.27)   3.867   2.162       1.529 
   12      27.571   4.785    7.520  (242.91,258.60,193.26)   8.260   3.986       3.986 
   13      35.515   7.520    9.570  (245.55,258.61,198.19)  11.023   3.486       3.986 
   14      33.178   6.152    7.520  (249.20,258.89,202.41)   7.794   4.323       4.323 
   15      24.300   4.785   10.254  (249.65,259.46,208.11)   8.456   2.734       2.819

Measurements from Aug. 1999.

Tube Geometry Analysis Summary
Date            : Mon Aug 23 19:18:31 1999
Oblique slices  : 15
Segmented image : airseg2.s10-85_int
Note            : Measurements for the trachea just below the tube.
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      49.534  12.305    4.102  (303.34,240.55, 84.65)  11.801   3.418       3.486 
    2      56.543  12.305    6.152  (302.02,243.39, 89.42)  12.324   4.586       4.977 
    3      49.534   9.570    6.836  (301.39,245.66, 94.52)  10.162   5.511       5.841 
    4      52.338   8.203    8.887  (300.70,249.19, 98.84)   9.859   5.511       5.880 
    5      58.880   8.887    9.570  (298.88,251.97,103.43)  11.212   5.511       5.880 
    6      71.497  11.621    9.570  (297.31,252.76,108.81)  13.483   6.114       7.038 
    7      78.507  11.621    9.570  (296.77,254.06,114.19)  12.898   7.643       7.972 
    8      68.226  10.254   10.254  (296.16,255.62,119.50)  11.958   7.038       7.038 
    9      57.011   9.570   10.254  (297.59,253.90,125.10)  11.621   5.880       6.449 
   10      50.936   8.203    9.570  (296.81,255.94,130.72)  10.093   5.880       6.449 
   11      60.749   8.203   11.621  (294.82,258.47,135.73)  12.568   6.114       6.114 
   12      73.366   9.570   13.672  (295.32,258.17,141.65)  15.286   6.114       6.114 
   13      59.814   8.203   12.988  (294.54,259.42,147.21)  13.757   5.206       5.511 
   14      76.170   8.203   12.988  (292.26,261.43,152.11)  13.465   5.511       5.511 
   15     108.881  10.254   16.406  (293.60,261.84,158.32)  17.144   7.643       8.260

Measurements from Nov. 2000.

Tube Geometry Analysis Summary
Date            : Thu Dec 14 19:25:17 2000
Oblique slices  : 15
Segmented image : 1121002dseg1_int
Original image  :1121002dseg1_int

Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      26.553   6.838    5.318  (232.83,228.59, 59.62)   7.005   3.799       4.805 
    2      27.708   9.117    5.318  (231.80,234.99, 62.39)   9.610   1.699       1.699 
    3      20.781   6.838    3.039  (231.47,239.37, 65.17)   7.208   2.403       2.403 
    4      29.439   6.838    4.559  (230.10,242.84, 68.80)   7.208   3.799       4.091 
    5      19.626   5.318    6.078  (229.23,246.78, 72.06)   7.168   2.403       2.739 
    6      18.472   4.559    5.318  (227.79,249.96, 75.90)   6.125   2.403       2.403 
    7      24.244   4.559    6.838  (226.51,251.77, 80.65)   6.880   3.039       3.133 
    8      30.594   6.838    7.598  (226.90,252.78, 85.79)   8.076   3.874       4.865 
    9      26.553   4.559    6.838  (228.92,254.18, 90.30)   7.208   3.874       4.430 
   10      26.553   5.318    7.598  (229.82,254.98, 95.29)   8.183   3.398       3.398 
   11      30.017   6.078    7.598  (230.38,256.29,100.18)   8.076   3.398       4.430 
   12      38.675   7.598    9.877  (231.12,257.97,104.93)  10.334   3.133       4.865 
   13      40.407   6.078   10.637  (232.85,259.76,109.78)  11.572   3.398       3.398 
   14      46.757   6.838   11.396  (234.76,261.15,114.69)  12.013   5.318       5.786 
   15      33.480   3.799   12.156  (234.26,264.59,119.22)  11.795   2.149       2.403


Measurements from Feb. 2001.

Tube Geometry Analysis Summary
Date            : Tue Apr 10 14:10:32 2001
Oblique slices  : 31
Segmented image : airseg.s1-195_int
Original image  : 022301
Note            : trachea

Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      27.400   6.696    5.580  (249.37,252.56, 67.67)   6.719   3.348       3.946 
    2      24.286   6.696    4.464  (247.69,257.03, 69.07)   6.902   3.005       3.005 
    3      26.777   7.812    3.906  (246.08,260.36, 70.80)   7.989   2.845       2.845 
    4      33.005   7.812    5.580  (245.29,262.97, 73.84)   7.812   3.005       3.348 
    5      34.250   6.696    6.138  (244.32,265.89, 76.43)   7.891   4.499       4.735 
    6      27.711   5.022    7.254  (243.03,268.57, 79.13)   7.752   3.529       4.024 
    7      24.286   5.022    8.370  (243.82,271.00, 82.31)   8.823   2.790       4.062 
    8      19.927   4.464    6.138  (243.15,273.26, 85.64)   6.742   3.157       3.529 
    9      22.107   4.464    7.254  (241.13,275.22, 88.89)   7.275   3.254       3.946 
   10      24.909   5.022    7.254  (240.47,276.80, 92.83)   6.902   3.946       4.062 
   11      16.191   3.906    6.696  (241.68,276.94, 97.35)   6.719   2.790       3.348 
   12      20.550   5.022    6.696  (239.06,278.07,101.06)   6.788   3.005       2.845 
   13      21.484   6.138    5.022  (240.27,278.17,105.53)   6.507   3.573       3.573 
   14      27.089   6.696    7.254  (239.53,279.76,109.82)   6.313   4.024       5.524 
   15      32.382   7.812    7.254  (242.28,279.14,113.32)   7.590   3.743       4.800 
   16      57.602  10.044   11.718  (244.87,277.64,116.67)  12.651   4.358       4.358 
   17      48.261   8.370    7.812  (247.59,277.90,120.14)   8.370   5.145       7.590 
   18      41.723   8.370   11.160  (247.53,275.69,123.97)  11.503   3.394       3.743 
   19      75.350  10.044   12.834  (247.68,274.87,127.90)  13.725   6.902       7.752 
   20      66.943   8.928   11.718  (247.57,273.57,131.70)  13.228   6.507       6.992 
   21      73.171  11.718   11.718  (247.37,273.96,135.64)  12.477   6.362       6.992 
   22      77.841  11.160   13.950  (247.00,274.86,139.49)  15.025   6.696       6.742 
   23      81.577  12.834   13.392  (247.70,275.01,143.62)  13.950   6.742       8.662 
   24      70.680   8.370   13.950  (245.97,276.45,147.17)  13.804   5.691       5.691 
   25      81.889   8.370   15.066  (246.89,278.26,150.89)  15.564   6.719       8.125 
   26      91.230  10.044   16.182  (244.47,280.14,153.83)  16.591   5.580       6.531 
   27      85.002   7.254   17.298  (245.13,280.83,157.81)  17.477   5.608       5.826 
   28      98.391   8.928   16.740  (244.89,283.69,160.73)  16.786   5.745       6.362 
   29     108.666   8.928   17.298  (245.43,285.08,164.45)  17.619   7.832       7.989 
   30     115.827  10.602   17.856  (244.52,286.42,168.12)  16.647   6.742       7.445 
   31      78.775   9.486   15.624  (239.76,287.48,169.97)  13.680   5.826       6.239


Summary

This case demonstrates a severe complex inflammatory stenosis that has required multiple therapeutic approaches. The reconstructed image has enabled placement of a silicon stent, although it did not stay in place because of the variation in tracheal size. The patient in currently being considered for a nitinolol stent with tracheal transplantation an option in the future.



©1994-2002 Division of Physiologic Imaging, Dept. of Radiology, Univ. of Iowa


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