Bhalla M, Grillo H C, McLoud T C, Shepard J O, Weber A L, Mark E J
Department of Radiology, Massachusetts General Hospital, Boston 02114.
AJR Am J Roentgenol. 1993 Sep;161(3):515-7. doi: 10.2214/ajr.161.3.8352095.
Acquired nonneoplastic laryngotracheal stenosis can be either focal or diffuse. Diffuse tracheal stenosis is caused by sarcoidosis, tuberculosis, histoplasmosis, relapsing polychondritis, tracheopathia osteoplastica, and Wegener's granulomatosis. Focal tracheal stenosis, on the other hand, usually results from placement of an endotracheal or tracheostomy tube or from previous neck trauma. At our institution, since 1971, we have seen 49 cases of focal laryngotracheal stenosis that could not be attributed clinically or histologically to any one of the aforementioned causes. The purpose of this study was to study the radiologic features of these idiopathic laryngotracheal stenoses.
A retrospective review of records showed that radiologic studies were still available in only 15 of the 49 patients with idiopathic laryngotracheal stenoses. All 15 patients had radiographs and plain tomograms, and one patient had a CT scan of the neck. Three radiologists reviewed all the images.
The radiologic appearance was variable: the stenoses were from 2 to 4 cm long with a lumen between 3 and 5 mm in diameter at the narrowest portion. The narrowing was concentric and shaped like an hourglass in eight patients (53%) and was eccentric in the other seven (47%). The margins of the stenosis were smooth in nine patients (60%) and irregular and lobulated in six patients (40%). A dominant mass measuring approximately 1 cm in diameter was present in two patients (13%). No evidence of calcification or ossification was seen.
Idiopathic laryngotracheal stenosis produces focal stenosis of the cervical part of the trachea, 2 to 4 cm long. The lumen is severely compromised, measuring no more than 5 mm in diameter at its narrowest portion. The stenosis can be concentric or eccentric and can have either smooth or lobulated margins. Special attention should be paid to the airways when chest radiographs of patients with a history of prolonged dyspnea and wheezing are reviewed. The prevalence of focal stenosis of the larynx and the upper part of the trachea due to tracheal intubation has declined since the introduction of low-pressure, high-volume retention cuffs. Therefore, idiopathic laryngotracheal stenosis should be considered in the differential diagnosis in patients with focal narrowing of the airway.
获得性非肿瘤性喉气管狭窄可为局限性或弥漫性。弥漫性气管狭窄由结节病、结核病、组织胞浆菌病、复发性多软骨炎、骨化性气管病和韦格纳肉芽肿引起。另一方面，局限性气管狭窄通常由气管内插管或气管造口管的放置或先前的颈部创伤导致。自1971年以来，在我们机构共诊治了49例局限性喉气管狭窄病例，临床及组织学检查均无法归因于上述任何一种病因。本研究的目的是探讨这些特发性喉气管狭窄的放射学特征。
回顾性查阅病历发现，49例特发性喉气管狭窄患者中仅有15例仍留存放射学检查资料。15例患者均有X线片和平片体层摄影，1例患者进行了颈部CT扫描。由3名放射科医生阅片。
放射学表现多样：狭窄段长2至4厘米，最窄处管腔直径3至5毫米。8例患者（53%）狭窄呈同心性，呈沙漏状；另7例患者（47%）呈偏心性。9例患者（60%）狭窄边缘光滑，6例患者（40%）边缘不规则呈分叶状。2例患者（13%）可见一直径约1厘米的主要肿块。未见钙化或骨化迹象。
特发性喉气管狭窄导致气管颈部局限性狭窄，长2至4厘米。管腔严重狭窄，最窄处直径不超过5毫米。狭窄可为同心性或偏心性，边缘可光滑或呈分叶状。对有长期呼吸困难和喘息病史患者的胸部X线片进行阅片时，应特别注意气道情况。自采用低压、大容量留置气管套囊以来，因气管插管导致的喉及气管上段局限性狭窄的发生率有所下降。因此，气道局限性狭窄患者的鉴别诊断中应考虑特发性喉气管狭窄。
