title: Novel multimodality imaging and physiologic assessments clarify choke-point physiology and airway wall structure in expiratory central airway collapse.
abstract: Choke points and airway wall structure in expiratory central airway collapse are poorly defined. Computed tomography, white light bronchoscopy, endobronchial ultrasound, vibration response imaging, spirometry, impulse oscillometry, negative expiratory pressure, and intraluminal catheter  airway pressure measurements were used in a patient with cough, dyspnea, and recurrent pulmonary infections. Computed tomography and white light bronchoscopy identified dynamic collapse of the trachea and mainstem bronchi, consistent with severe crescent tracheobronchomalacia. Spirometry showed  severe obstruction. Endobronchial ultrasound revealed collapse of the airway cartilage, and vibration response imaging revealed fluttering at both lung zones. Impulse oscillometry and negative expiratory pressure suggested tidal expiratory flow limitation in the intrathoracic airways. Intraluminal  catheter airway pressure measurements identified the choke point in the lower trachea. After Y-stent insertion, the choke point migrated distally. Imaging studies revealed improved airway dynamics, airway patency, and ventilatory function. Novel imaging and physiologic assessments could be  used to localize choke points and airway wall structure in tracheobronchomalacia.
authors: Department of Internal Medicine, St . Marianna University School of Medicine, Kawasaki, Japan.
authors: Hiroshi
authors: H
authors: Handa
authors: Teruomi
authors: T
authors: Miyazawa
authors: Septimiu D
authors: SD
authors: Murgu
authors: Hiroki
authors: H
authors: Nishine
authors: Noriaki
authors: N
authors: Kurimoto
authors: Jyongsu
authors: J
authors: Huang
authors: Henri G
authors: HG
authors: Colt
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis* / Q000503:physiopathology; D001980:Bronchi / Q000000981:diagnostic imaging; D001999:Bronchoscopy; D003251:Constriction, Pathologic; D003952:Diagnostic Imaging / Q000379:methods*; D019160:Endosonography; D006801:Humans; D008297:Male; D009991:Oscillometry; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000503:physiopathology*; D013147:Spirometry; D015607:Stents; D055089:Tracheobronchomalacia / Q000175:diagnosis* / Q000503:physiopathology; D014732:Vibration