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Saber sheath trachea

Radswiki and Dr Frank Gaillard et al.

Saber-sheath trachea refers to diffuse coronal narrowing of the intra-thoracic portion of the trachea with concomitant widening of the sagittal diameter. It is not uncommon and is pathognomonic for chronic obstructive pulmonary disease (COPD) ¹.

The sagittal:coronal diameter is over 2:1 ² and the extra-thoracic portion of the trachea is not narrowed.

Radiographic features

Marked decrease in the coronal diameter of the intra-thoracic trachea associated with an increase in its sagittal diameter.

On CT additional features may include:

inward bowing or displacement of the lateral tracheal walls as a result of cartilage weakness
mild intra-thoracic tracheal wall thickening
ossification of tracheal rings
during forceful expiration, there may be further inward bowing

References

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1. Marom EM, Goodman PC, Mcadams HP. Diffuse abnormalities of the trachea and main bronchi. AJR Am J Roentgenol. 2001;176 (3): 713-7. AJR Am J Roentgenol (full text) - Pubmed citation
2. Webb EM, Elicker BM, Webb WR. Using CT to diagnose nonneoplastic tracheal abnormalities: appearance of the tracheal wall. AJR Am J Roentgenol. 2000;174 (5): 1315-21. AJR Am J Roentgenol (full text) - Pubmed citation