Application of Dynamic Analysis by Multi-Detector CT in Determining the Treatment Strategy for Tracheal Stenosis : A Case Report

Introduction : Tracheal stenosis can be congenital or rarely occurs after prolonged endotracheal intubation or tracheostomy and can sometimes be a serious airway emergency. Precise assessment of the site of stenosis is desirable for treatment, and CT and endoscopy are the two most useful examinations. However, owing to changes over time caused by breathing and vocalization of the glottis, CT can be difficult to properly evaluate, especially with subglottic stenosis. Endoscopic evaluation of the subglottis and trachea is difficult. Case and Course : A 15-year-old male was referred from a local otorhinolaryngology clinic to our hospital because of suspected subglottic stenosis. He had a history of endotracheal intubation for general anesthesia surgery at nine years of age, but there were no notable findings at the time of intubation. CT revealed tracheal stenosis at the cricoid cartilage level. The endoscopic findings suggested the presence of a prominent stenotic origin at the subglottic level, and the possibility of overlapping subglottic stenosis could not be ruled out. Therefore, we performed dynamic imaging of the larynx during vocalization, non-vocalization, and respiratory fluctuation using multi-detector CT, which is now under study under the approval of the Ethics Committee of our University. The area of tracheal stenosis was fixed with little dynamic change and the origin of the stenosis was not observed in the subglottis. A tracheotomy was performed, the scar stenosis site was electrocauterized with a scalpel under general anesthesia, balloon dilation was performed, and a T-tube was implanted. After confirming the absence of restenosis, the T-tube was removed after 6 months, and the tracheal foramen was closed. Discussion : The pathophysiology of tracheal stenosis varies widely and requires careful consideration prior to therapeutic intervention. We experienced a case in which a dynamic analysis using multi-detector CT was useful in evaluating stenosis and deciding on a treatment plan for a patient with tracheal stenosis. As this analysis can dynamically observe areas that change with breathing and speech, it will be useful in situations where strict evaluation of the area is required, such as airway stenosis.