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Congress: ECR25
Poster Number: C-27441
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-27441
Authorblock: K. Boulougouri, P. Kumar, N. Numbere; BRIGHTON/UK
Disclosures:
Konstantina Boulougouri: Nothing to disclose
Parveen Kumar: Nothing to disclose
Numbere Numbere: Nothing to disclose
Keywords: Lung, Respiratory system, CT, Diagnostic procedure, Chronic obstructive airways disease
Learning objectives To present the typical CT findings that can help diagnose Expiratory Central Airway Collapse (ECAC), an often-missed airway pathology in the investigation of dyspnoea.Radiologists can play a pivotal role in suggesting the diagnosis on routinely performed CT that includes the Chest. Specific CT scanning protocols are helpful to confirm ECAC non-invasively and avoid bronchoscopy.
Read more Background Definition: ECAC is the term used to encompass two entities, Tracheomalacia (TBM) and Excessive Dynamic Airway Collapse (EDAC). ECAC can be congenital or acquired.Both conditions affect the collapsibility of the trachea and/or bronchi and result in reduced luminal diameter during expiration but have different pathogenesis and result in different tracheal morphology in exhale.Traditionally TBM was defined as > 50% of reduction of the tracheal diameter between inspiration and expiration. This cut off is still applied for TBM diagnosis in the...
Read more Findings and procedure details Diagnosis The "Gold standard" diagnostic test is dynamic awake bronchoscopy, during which the airways can be observed in different phases of breathing, cough etc.  Lung function tests are not diagnostic or specific and can even be normal.There are findings indicative of ECAC in CT Chest and CT Pulmonary Angiograms (CTPA), commonly performed in the investigation of dyspnoea; it is important that the Radiologists recognise these CT features and suggest the diagnosis. A dedicate biphasic CT scan can help support a...
Read more Conclusion Awareness of ECAC and its prevalence is limited and remains underdiagnosed. CT Chest can demonstrate specific features to support the diagnosis. The Radiologist can be the first clinician suspecting ECAC on common CT Chest and CTPA and should alert the treating physicians. Biphasic CT Chest in inspiration and expiration is an accurate non-invasive diagnostic test and a good alternative to Dynamic awake Bronchoscopy, provided a dedicated protocol is used and the patient gets appropriate guidance during scanning.
Read more References 1. Zhou P, Yu W, Zhang W, Ma J, Xia Q, He C. COPD-Associated Expiratory Central Airway Collapse: Current Concepts and New Perspectives. Chest. 2024 Nov 22:S0012-3692(24)05587-9. doi: 10.1016/j.chest.2024.11.015. Epub ahead of print. PMID: 395801122. Aslam A, De Luis Cardenas J, Morrison RJ, Lagisetty KH, Litmanovich D, Sella EC, Lee E, Agarwal PP. Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Current Concepts and Future Directions. Radiographics. 2022 Jul-Aug;42(4):1012-1027. doi: 10.1148/rg.210155. Epub 2022 May 6. PMID: 35522576.3. Boiselle PM, O'Donnell CR, Bankier AA,...
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