Tracheal stenosis

Last revised by Masoud Farhadi on 13 Feb 2024

Tracheal stenosis is usually acquired following intubation or tracheostomy. It can also arise as part of the spectrum of tracheobronchial stenosis.

Pathology

Inflammation and pressure necrosis of the tracheal mucosa most commonly occur at either the tracheostomy stoma or at the level of the tube balloon. Acute post-intubation stenosis results from mucosal edema or granulation tissue.

Post-intubation stenosis can extend for several centimeters and typically involves trachea above the level of the thoracic inlet.

Post-tracheostomy stenosis typically begins 1 to 1.5 cm distal to the inferior margin of the tracheostomy stoma and involves 1.5 to 2.5 cm of tracheal wall.

In patients with chronic stricture, tracheomalacia may result from weakness of tracheal cartilage and can be a cause of dyspnea.

Radiographic features

Plain radiograph

Narrowing of tracheal air shadow.

CT

Eccentric or concentric soft tissue thickening internal to normal-appearing tracheal cartilage may be visible. The outer tracheal wall has a normal appearance without evidence of deformity or narrowing. Expiratory CT shows little change in tracheal diameter.

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Cases and figures

  • Case 1: post-intubation
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  • Case 2: post-intubation
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  • Case 3: extrinsic compression by diffuse idiopathic skeletal hyperostosis (DISH)
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  • Case 4: post-intubation
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