Barnes Daniel, Gutiérrez Chacoff José, Benegas Mariana, Perea Rosario J, de Caralt Teresa M, Ramirez José, Vollmer Ivan, Sanchez Marcelo
Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Radiology Department, Clínica Dávila de Santiago, Santiago, Chile.
Insights Imaging. 2017 Apr;8(2):255-270. doi: 10.1007/s13244-017-0545-6. Epub 2017 Feb 15.
To describe the imaging features of the central airway pathology, correlating the findings with those in pathology and virtual endoscopy. To propose a schematic and practical approach to reach diagnoses, placing strong emphasis on multidetector computed tomography (MDCT) findings.
We reviewed our thoracic pathology database and the central airway pathology-related literature. Best cases were selected to illustrate the main features of each disease. MDCT was performed in all cases. Multiplanar and volume-rendering reconstructions were obtained when necessary. Virtual endoscopy was obtained from the CT with dedicated software.
Pathological conditions affecting the central airways are a heterogeneous group of diseases. Focal alterations include benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse abnormalities are divided into those that produce dilation and those that produce stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the mucosal layer and is an important diagnostic and therapeutic weapon. However, assessing the deep layers or the adjacent tissue is not possible. MDCT and post-processing techniques such as virtual bronchoscopy (VB) provide an excellent evaluation of the airway wall.
This review presents the complete spectrum of the central airway pathology with its clinical, pathological and radiological features.
• Dividing diseases into diffuse and focal lesions helps narrow the differential diagnosis. • Focal lesions with nodularity are more likely to correspond to tumours. • Focal lesions with stenosis are more likely to correspond to inflammatory disease. • Posterior wall involvement is the main feature in diffuse lesions with stenosis.
描述中央气道病变的影像学特征，将这些发现与病理学和虚拟内镜检查的结果相关联。提出一种系统且实用的诊断方法，重点强调多排螺旋计算机断层扫描（MDCT）的表现。
我们回顾了胸部病理学数据库以及与中央气道病变相关的文献。挑选出最佳病例以说明每种疾病的主要特征。所有病例均进行了MDCT检查。必要时进行多平面和容积再现重建。使用专用软件从CT图像中获取虚拟内镜图像。
影响中央气道的病理状况是一组异质性疾病。局灶性病变包括良性肿瘤、恶性肿瘤和非肿瘤性疾病。弥漫性异常分为导致扩张的和导致狭窄及气管支气管软化的。直接支气管镜检查（DB）可观察黏膜层，是重要的诊断和治疗手段。然而，无法评估深层或邻近组织。MDCT及虚拟支气管镜检查（VB）等后处理技术能对气道壁进行出色的评估。
本综述展示了中央气道病变的全貌及其临床、病理和放射学特征。
• 将疾病分为弥漫性和局灶性病变有助于缩小鉴别诊断范围。• 有结节的局灶性病变更可能为肿瘤。• 有狭窄的局灶性病变更可能为炎症性疾病。• 后壁受累是弥漫性狭窄病变的主要特征。
