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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Expiratory stenosis of the trachea and the main bronchi is caused first of all by slackening of the pars membranacea in rarer cases by tracheomalacia or tracheomegalia. Often it is associated with other respiratory diseases above all tracheobronchitis, emphysema and pneumosclerosis. Predominant clinical symptoms are dyspnoea, barking cough and attacks of suffocation. X-ray-pictures in several diameters and levels and bronchological examinations are crucial for securiting the diagnosis. Among 95 patients of all age groups 14 were operated on predominantly according to the method of NISSEN. Operation is contradicted in stages of severe emphysema with respiratory insufficiency of bilateral pulmonary tuberculosis or of chronic bronchitis. In 10 patients a good result was achieved by the operation.
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PMID:[Surgery of expiratory stenosis of the thoracic part of the trachea and main bronchi (author's transl)]. 79 6

Twenty of 30 patients with bronchopulmonary dysplasia (BPD) had major tracheobronchial abnormalities, which in 18 could be incriminated as contributing to their symptoms. There were 15 examples of tracheobronchial stenosis, 13 of tracheomalacia, nine of bronchomalacia, and one of tracheal web. Sixteen patients had operations. Tracheostomy was successful as a temporizing measure in ten patients although there was significant morbidity. Balloon dilatation of tracheobronchial stenosis produced temporary (2) or long-term (2) improvement in four patients. Electroresection of tracheobronchial stenosis was successful in the three instances it was employed. Lobectomy for lobar emphysema was curative in both patients. Aortopexy for tracheomalacia improved all three patients. We conclude that (1) symptomatic major airway lesions are not uncommon manifestations of BPD, (2) many of the lesions are amenable to surgical therapy, and (3) bronchoscopic evaluation should be considered early in the course of infants with BPD.
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PMID:Surgical implications of bronchopulmonary dysplasia. 344 Aug 99

We describe seven patients who had intrathoracic airway obstruction resulting in severe respiratory distress. The patients were a four month old with bronchial cartilage hypoplasia presenting as congenital lobar emphysema; a one month old with segmental bronchomalacia; a one month old with tracheal bronchus; a two day old and a seven month old with aneurysmal distension of the pulmonary arteries secondary to tetralogy of Fallot, with absent pulmonary valve and atrioventricular canal with pulmonary poststenotic dilatation, respectively; a three year old with double aortic arch forming a vascular ring; and a three month old with tracheomalacia from tracheoesophageal fistula. The patients had various associated congenital defects, and all of them required one or more surgical procedures to repair the defects and relieve the airway obstruction. Five patients received endotracheal intubation with mechanical ventilation on their first admission, and three of them died postoperatively. The diagnostic workup to delineate the anatomic factors causing the obstruction, as well as to determine the therapeutic medical and surgical strategies to relieve it, are described. We conclude that the course of illness in most pediatric patients with intrathoracic airway obstruction is complex, is associated with high morbidity and mortality, and entails extensive multidisciplinary diagnostic and therapeutic efforts.
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PMID:Pediatric intrathoracic large airway obstruction: diagnostic and therapeutic considerations. 789 24

Computed tomography (CT) is the method of choice for the morphological assessment of pulmonary structure. Airways. pulmonary parenchyma and their pathologies are shown with high spatial resolution. Airway diseases exhibit bronchial dilatation, wall thickening and an increased visibility in the lung periphery. CT is also the imaging gold standard for the detection and the characterisation of emphysema because a high degree of concordance with histopathological studies. Centrilobular, panlobular and paraseptal emphysema can be differentiated. CT can also provide functional information. Paired inspiratory and expiratory scans with or without spirometric triggering allow to evaluate obstruction of the small airways (airtrapping). On the basis of CT-data lung volumes can be semented. Cine-CT allows to visualise motion of the central airways. e.g. in tracheomalacia, to assess regional ventilation to calculate pulmonary time constants. and to display the co-ordinated or dissociated motion of the thoracic wall and the diaphragm. Beyond the mere high-resolution visualisation of the structure of the lung the application of these CT-strategies makes a regional assessment of pulmonary function possible.
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PMID:[Pulmonary structure and function]. 1179 55

Congenital anomalies of the chest are an important cause of morbidity in infants, children, and even adults. The evaluation of affected patients frequently requires multiple imaging modalities to diagnose the anomaly and plan surgical correction. The authors analyze and illustrate practical aspects of certain common and uncommon congenital anomalies affecting the tracheobronchial tree, lung, and mediastinum, with emphasis on radiologic manifestations. Other thoracic anomalies such as rib anomalies and vascular rings are discussed when they are associated with anomalies of the tracheobronchial tree. The usefulness of the various imaging modalities in the diagnosis and treatment of these conditions is also evaluated. Specific topics addressed include tracheal conditions such as tracheal stenosis, tracheomalacia, tracheal bronchus, tracheal atresia, and bronchogenic cyst; anomalies of the lung such as lung underdevelopment (agenesis and hypoplasia), scimitar syndrome, congenital cystic adenomatoid malformation, congenital lobar emphysema, and pulmonary sequestration; esophageal anomalies such as esophageal atresia, tracheoesophageal fistula, and esophageal duplications; and vascular rings. The embryologic and pathologic basis of the radiologic findings are discussed in appropriate cases. Differential diagnoses, as well as pitfalls and diagnostic difficulties, are included.
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PMID:Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. 1461 Feb 45

Respiratory distress due to either medical or surgical causes occurs commonly in neonates. It is the most common cause of admission to a neonatal surgical intensive care facility in a tertiary care hospital. The distress can be caused by a variety of clinical conditions; common conditions treated in medical intensive care units are transient tachypnea of the new born, respiratory distress syndrome, pulmonary air leak and pneumothorax. In surgical causes of respiratory distress in neonates the underlying mechanisms include airway obstruction, pulmonary collapse or displacement and parenchymal disease or insufficiency; the common causes are congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, congenital lobar emphysema and esophageal atresia with or without tracheo-esophageal fistula. Obstructive lesions of the new born airway include choanal atresia, macroglossis, Pierre-Robin syndrome, lymphangioma, teratoma or other mediastinal masses, cysts, subglottic stenosis and laryngo tracheomalacia. Imaging plays a very major role in the pre-operative diagnosis of these conditions and proper pre-operative resuscitation helps in improving the results of surgery dramatically.
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PMID:Respiratory distress in neonates. 1597 26

The aim of this study was to determine the prevalence of airway malacia and its relationship with ancillary morphologic features in patients with chronic obstructive pulmonary disease (COPD). A retrospective review was performed of a consecutive series of patients with COPD who were imaged with inspiratory and dynamic expiratory multidetector computed tomography (MDCT). Airway malacia was defined as > or =50% expiratory reduction of the airway lumen. Both distribution and morphology of airway malacia were assessed. The extent of emphysema, extent of bronchiectasis and severity of bronchial wall thickness were quantified. The final study cohort was comprised of 71 patients. Airway malacia was seen in 38 of 71 patients (53%), and such proportion was roughly maintained in each stage of COPD severity. Almost all tracheomalacia cases (23/25, 92%) were characterised by an expiratory anterior bowing of the posterior membranous wall. Both emphysema and bronchiectasis extent did not differ between patients with and without airway malacia (p > 0.05). Bronchial wall thickness severity was significantly higher in patients with airway malacia and correlated with the degree of maximal bronchial collapse (p < 0.05). In conclusion, we demonstrated a strong association between airway malacia and COPD, disclosing a significant relationship with bronchial wall thickening.
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PMID:Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening. 1920 3

Stem/progenitor cells can be used to repair defects in the airway wall, resulting from e.g., tumors, trauma, tissue reactions following long-time intubations, or diseases that are associated with epithelial damage. Several potential sources of cells for airway epithelium have been identified. These can be divided into two groups. The first group consists of endogenous progenitor cells present in the respiratory tract. This group can be subdivided according to location into (a) a ductal cell type in the submucosal glands of the proximal trachea, (b) basal cells in the intercartilaginous zones of the lower trachea and bronchi, (c) variant Clara cells (Clara v-cells) in the bronchioles and (d) at the junctions between the bronchioles and the alveolar ducts, and (e) alveolar type II cells. This classification of progenitor cell niches is, however, controversial. The second group consists of exogenous stem cells derived from other tissues in the body. This second group can be subdivided into: (a) embryonic stem (ES) cells, induced pluripotent stem (iPS) cells, or amniotic fluid stem cells, (b) side-population cells from bone marrow or epithelial stem cells present in bone marrow or circulation and (c) fat-derived mesenchymal cells. Airway epithelial cells can be co-cultured in a system that includes a basal lamina equivalent, extracellular factors from mesenchymal fibroblasts, and in an air-liquid interface system. Recently, spheroid-based culture systems have been developed. Several clinical applications have been suggested: cystic fibrosis, acute respiratory distress syndrome, chronic obstructive lung disease, pulmonary fibrosis, pulmonary edema, and pulmonary hypertension. Clinical applications so far are few, but include subglottic stenosis, tracheomalacia, bronchiomalacia, and emphysema.
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PMID:Tissue engineering and the use of stem/progenitor cells for airway epithelium repair. 2057 96

Schimke Immuno-osseous Dysplasia (SIOD) is a rare genetic disorder with multiple systemic manifestations. Pulmonary manifestations have been described but not well characterized. They are believed to be secondary to decreased elasticity, and include emphysema, pulmonary hypertension and bronchiectasis. We describe a 24-year-old female patient with SIOD with tracheobronchial anomalies not reported before, including tracheomalacia and a tracheal bronchus with Epstein-Barr virus (EBV) related leiomyoma causing endobronchial obstruction. Such anomalies, in addition to the difficult upper airway associated with SIOD present specific challenges during management. This case reports documents tracheobronchial abnormalities that have not been described before in SIOD.
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PMID:Tracheobronchial anomalies in a patient with Schimke immuno-osseous dysplasia (SIOD). 2542 99

Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies.
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PMID:Operative endoscopy of the airway. 2698 Dec 63


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