Air trapping in chest imaging refers to retention of excess gas (“air”) in all or part of the lung, especially during expiration, either as a result of complete or partial airway obstruction or as a result of local abnormalities in pulmonary compliance. It may also sometimes be observed in normal individuals 3.
Although not in common usage, the term gas trapping is more accurate ref.
Air trapping is common, occurring in ~50% of CT thorax examinations 6.
Mild (<25% parenchyma) air trapping may be commonly symptomatic or clinically insignificant 6.
The presence of air trapping can arise from a number of causes (the mnemonic HSBC can be used to help remember these) but usually suggests airway disease (often small airways disease). Air trapping can occur in isolation, or in association with bronchiectasis, interstitial lung disease, or rarely tree-in-bud opacity, which can help narrow the etiology 3,6:
- in isolation
- with bronchiectasis
- with interstitial lung disease
Other uncommon conditions include 5,6:
- neuroendocrine cell proliferation spectrum
- diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) 7
- scoliosis: especially when severe
Air trapping is a descriptor used in lung CT seen as a decreased attenuation of pulmonary parenchyma, especially manifested as a less than normal increase in attenuation during expiratory acquisition. This appearance must be differentiated from the decreased attenuation of hypoperfusion secondary to locally increased pulmonary arterial resistance 1.
The concurrent presence of absence or bronchiectasis and interstitial lung disease may be useful to narrow the differential possibilities 10.
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- 2. Webb WR, Műller NL, Naidich DP. High-resolution CT of the lung. Lippincott Williams & Wilkins. (2008) ISBN:0781769094. Read it at Google Books - Find it at Amazon
- 3. Tanaka N, Matsumoto T, Miura G et-al. Air trapping at CT: high prevalence in asymptomatic subjects with normal pulmonary function. Radiology. 2003;227 (3): 776-85. doi:10.1148/radiol.2273020352 - Pubmed citation
- 4. Arakawa H, Webb WR. Air trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities: correlation with pulmonary function tests and differential diagnosis. AJR Am J Roentgenol. 1998;170 (5): 1349-53. Pubmed citation
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- 6. Miller WT, Chatzkel J, Hewitt MG. Expiratory air trapping on thoracic computed tomography. A diagnostic subclassification. Ann Am Thorac Soc. 2014;11 (6): 874-81. doi:10.1513/AnnalsATS.201311-390OC - Pubmed citation
- 7. Benson, R., Rosado-de-Christenson, M., Martínez-Jiménez, S., et al (2013). Spectrum of Pulmonary Neuroendocrine Proliferations and Neoplasms. RadioGraphics, 33(6), pp.1631-1649. https://doi.org/10.1148/rg.336135506. http://pubs.rsna.org/doi/full/10.1148/rg.336135506
- 8. Onno M. Mets, Robert A. van Hulst, Colin Jacobs, et al. Normal Range of Emphysema and Air Trapping on CT in Young Men. (2012) American Journal of Roentgenology. 199 (2): 336-40. doi:10.2214/AJR.11.7808 - Pubmed
- 9. Lucidarme O, Grenier PA, Cadi M, et al. Evaluation of air trapping at CT: comparison of continuous-versus suspended-expiration CT techniques. (2000) Radiology. 216 (3): 768-72. doi:10.1148/radiology.216.3.r00se21768 - Pubmed
- 10. Wallace T. Miller, Jonathan Chatzkel, Michael G. Hewitt. Expiratory Air Trapping on Thoracic Computed Tomography. A Diagnostic Subclassification. (2014) Annals of the American Thoracic Society. 11 (6): 874-81. doi:10.1513/AnnalsATS.201311-390OC - Pubmed
- 11. Firdaus A. Mohamed Hoesein, Pim A. de Jong. Air trapping on computed tomography: regional versus diffuse. (2017) European Respiratory Journal. doi:10.1183/13993003.01791-2016 - Pubmed