What Is Thickening Bronchial

Fibrosing mediastinitis is a complication of granulomatous mediastinitis, resulting from infection from Histoplasma capsulatum and, less commonly, Mycobacterium tuberculosis. It has also been associated with the use of methysergide. Fibrosing mediastinitis is characterized by a proliferation of fibrous tissue in the mediastinum, which surrounds, invades, and sometimes obliterates normal structures, including the trachea and bronchi, esophagus, vena cava, pulmonary veins and arteries, and thoracic duct. Calcification is often present within the mediastinal fibrosis, identifiable on chest radiographs and CT (Figure 4-35). Contrast enhanced CT or MRI is useful to evaluate vascular invasion or occlusion by the fibrosis.47,48

figure 4-33 Tuberculous broncholithiasis. The posteroanterior chest radiograph (A) and anteroposterior tomogram (B) reveal collapse of the right upper lobe distal to a calcified right upper lobe-filling defect, consistent with a broncholith. C, A computed tomography scan reveals complete obstruction of the right upper lobe bronchus by a calcified endobronchial-filling defect associated with a densely calcified right paratracheal lymph node in a patient with healed tuberculosis.

Right Paratracheal Thickening

Sarcoidosis

Sarcoidosis of the larynx and trachea is characterized by diffuse or nodular thickening, and in some cases, a tumor-like infiltration. The epiglottis is most frequently involved. Other airway involvement includes tracheobronchial mural thickening, which may be smooth, irregular, or nodular luminal narrowing (Figure 4-36). Airway compression by lymphadenopathy may occur. Thickening of the tracheobronchial wall represents the presence of granulomas in the bronchial mucosa and along the bronchovascular interstitium, accounting for the high diagnostic success of transbronchial biopsy (Figure 4-37).49

Scleroma

Scleroma is caused by Klebsiella rhinoscleromatis, a gram-negative bacterium. It is a chronic granulomatous disorder that commonly involves the subglottic larynx and cervical trachea and is characterized by granu-

Distal Trachea And Bronchi
figure 4-35 Fibrosing mediastinitis. Computed tomography scans through the distal trachea (A) and main bronchi (B) with intravenous contrast reveal narrowing and distortion of the trachea and bronchi. There is surrounding fibrosis that contains calcification.

lomatous masses or nodular and diffuse infiltrations. Although the proximal trachea is most commonly involved, the entire trachea and even the main bronchi may be affected by obstruction. The radiologic findings correlate with the three clinical stages of inflammation: 1) the catarrhal stage, 2) the granulomatous proliferative stage, and 3) the sclerotic cicatricial stage.50

End Stage Bronchiectasis

figure 4-36 Tracheal stenosis in end-stage sarcoidosis. Posteroanterior (A) and lateral (B) chest radiographs reveal marked tracheal and bronchial stenosis and distortion. There is marked pulmonary fibrosis and traction bronchiectasis related to pulmonary sarcoidosis.

Tracheobronchial Calcification Nih

figure 4-37 Diffuse tracheobronchial stenosis in sarcoidosis. Computed tomography scans through the main bronchi (A) and left upper lobe bronchus (B) reveal diffuse bronchial wall thickening and calcification. Calcified subcarinal lymph nodes are noted.

Wegener's Granulomatosis

Wegener's granulomatosis may involve the upper and lower respiratory tract, usually in conjunction with renal and other organ involvement.51 Wegener's granulomatosis may involve the subglottic larynx and cause diffuse narrowing of the subglottic airway (Figure 4-38). Diffuse tracheobronchial involvement is rare and usually presents late in the disease process. Radiographic findings include tracheobronchial narrowing, thickening, and irregularity that may be focal or diffuse (Figures 4-39, 4-40). Occasionally, granulomatous tissue can obstruct a bronchus, causing atelectasis. Mediastinal and/or hilar adenopathy may be present on CT.

Other Benign Infiltrative Lesions Idiopathic Laryngotracheal Stenosis

Idiopathic laryngotracheal stenosis is a rare cause of narrowing of the larynx and cervical trachea that typically affects middle-aged women who have no history of trauma, infection, or systemic disorder. The stenotic areas show dense keloid fibrosis involving the adventitia and the lamina propria, sparing the mucosa, muscularis propria, and the cartilages. The radiographic appearance is variable, including smooth and tapered, or irregular, lobulated, and eccentric lesions that are 2 to 4 cm in length (Figure 4-41).52

Relapsing Polychondritis

Relapsing polychondritis is an uncommon multisystem disease causing progressive, episodic inflammation and destruction of hyaline cartilage and other tissues. Clinical manifestations include auricular chondritis, arthritis, nasal chrondritis, ocular inflammation, respiratory tract involvement, audiovestibular damage, cardiovascular involvement, and skin disease. Respiratory tract involvement is the major cause of death. Relapsing polychondritis thickens the laryngotracheal cartilages, causing airway narrowing adjacent to the epiglottis, aryepiglottic folds, glottis, subglottis, and upper trachea. Progressive thickening of the distal trachea and bronchi may develop, but this is less common.

There is a spectrum of findings in the airways.53,54 In the early stages of the disease, mucosal inflammation is present, causing thickening and narrowing of the central airways. As the disease progresses and

figure 4-38 Wegener's granulomatosis subglottic larynx. Axial computed tomography section shows diffuse soft tissue thickening of the subglottic larynx (asterisk) adjacent to the cricoid cartilage (arrow).

figure 4-39 Tracheal stenosis due to Wegener's granulomatosis. An oblique tomogram of the trachea reveals a diffuse tracheal stenosis with an hourglass configuration.

figure 4-39 Tracheal stenosis due to Wegener's granulomatosis. An oblique tomogram of the trachea reveals a diffuse tracheal stenosis with an hourglass configuration.

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Responses

  • Albert
    What is thickening bronchial?
    3 years ago
  • CLARE
    What Is diffuse bronchial wall thickening?
    2 years ago
  • athos
    What is lumininal irregular trachea?
    1 year ago
  • Evan
    What is thickening of the wind pipe?
    1 year ago
  • Jouni
    Can the bronchial wall be calcified?
    1 year ago
  • noora laiho
    How is bronchial wall thickening of the right lobe airways .?
    11 months ago
  • fnan
    What does mild bronchial wall thickening mean?
    9 months ago
  • angelica chubb
    What does thickening of the epigiottis mean with no symptoms?
    9 months ago
  • lalli
    What is meant by thickening of right lower bronchial zone?
    8 months ago
  • leanna
    Is there bronchi in the trachea?
    7 months ago
  • cora
    What does it mean when your Larynx thickens?
    6 months ago
  • Savanna
    What does it mean when you have mild thickening of the bilateral lower lobe bronchioles?
    5 months ago
  • HAMID
    What is mucosal thickening in thoracic area?
    3 months ago
  • fallon
    What would cause thickening of the bronchii?
    3 months ago
  • mandy
    What symptoms result from bronchial wall thickening?
    2 months ago
  • habte
    What is the diagnosis code for for bronchial wall thickening?
    1 month ago
  • doreen
    What does mural linear filling defests in trachea and main bronchi mean?
    3 days ago

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