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figure 4-41 Idiopathic tracheal stenosis. Anteroposterior tracheal tomograms in two separate patients reveal subglottic stenosis with a diffuse smooth stenosis (A) and a mass-like obstructing lesion of the proximal trachea (B).

cartilage is destroyed, the airways become collapsible and tracheobronchomalacia develops. Once the destroyed cartilages are replaced by fibrous tissue, a diffuse fixed stenosis develops (Figure 4-42). In such cases, CT demonstrates diffuse smooth thickening of the involved trachea and bronchi (Figure 4-43). Occasionally, calcification is seen within the thickened walls.

Tracheopathia Osteochondroplastica

Tracheopathia osteochondroplastica is a rare benign condition manifested by multiple hard osteocartilaginous masses in the submucosa of the anterior and lateral walls of the cervical and intrathoracic trachea and main bronchi (Figure 4-44). The posterior membranous wall is typically uninvolved, a finding that distinguishes this disease entity from other diffuse infiltrating diseases. The size and distribution of the nodules are best depicted by CT. Submucosal nodules may range in size from a few millimeters to larger obstructing nodules. Ossification within the nodules can be identified on CT scans. The tracheobronchial wall is characteristically rigid on inspiratory/expiratory CT scans and fluoroscopy.55

Amyloidosis

Tracheobronchial amyloidosis results from the extracellular deposition of an insoluble protein that stains with Congo red. Airway involvement is most commonly seen in the primary form of the disease. Although any portion of the airway can be involved, distal tracheal and bronchial involvement is more common. Amyloidosis of the airway may be focal or mass-like, mimicking a tumor, or may cause diffuse thickening of the tracheobronchial wall.56

figure 4-42 Relapsing polychondritis of the glottis and proximal trachea. An anteroposterior tomogram of the proximal trachea and larynx reveals a smooth subglottic stenosis.

figure 4-42 Relapsing polychondritis of the glottis and proximal trachea. An anteroposterior tomogram of the proximal trachea and larynx reveals a smooth subglottic stenosis.

figure 4-44 Tracheopathia osteochondroplastica. A, Anteroposterior tomogram reveals diffuse nodularity of the trachea and bronchi. B, Computed tomography scan at the level of the midtrachea demonstrates thickening and nodularity of the tracheal cartilage, sparing the membranous wall.

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