A patient experiencing loud, difficult breathing and a chronic cough, was diagnosed with tracheobronchomalacia (TBM) and referred to Radiology and the 3DQ Lab for imaging, assessment, and visualization. TBM is a rare condition caused by the weakening or collapse of the windpipe and/or bronchi (the two main airways leading to the lungs). TBM can be present at birth or develop later in life due to various factors such as chronic inflammation, infection, trauma, prolonged intubation, or certain medical conditions that affect airway cartilage. Symptoms are similar to other respiratory conditions such as asthma so accurate diagnosis is essential, and typically involves 3D imaging tests to assess the airway.
Figure A (Right): Visual reconstruction of the patient’s airway, animated to visualize inspiration and expiration.
The patient underwent dynamic inspiratory and expiratory CT scans to capture detailed cross-sections of the respiratory system. A skilled 3DQ Lab technologist segmented the trachea, bronchi, and lungs. Utilizing this data, a series of visual reconstructions, measurements, and videos were created to illustrate the airway and lung volumes. The images notably reveal bronchial narrowing and reduced capacity in the right lung. The comprehensive set of images was shared with the Stanford Department of Cardiothoracic Surgery to aid in treatment planning. Below are the provided images:
Figure B: Volume of the lungs during both inspiration and expiration.
Figure C: Volume of the bronchi during both inspiration and expiration.
Figure D: Rotational visual reconstructions of the airway during inspiration and expiration.
Figure E: Measurements at various points of the airway during inspiration and expiration.
Figure F: Fly-through of the left bronchus during expiration.
Figure G: Fly-through of the right bronchus during expiration.
A complex procedure called bronchoplasty was performed to reconstruct the patient’s weakened bronchi, reinforcing them with synthetic materials and stents to restore structural integrity. By stabilizing the airways, a bronchioplasty aims to improve airflow and alleviate breathing difficulties caused by TBM. This procedure requires careful consideration by specialists due to its intricacy and lasting impact on the patient’s respiratory function.