Adult expiratory wheezing or post-extubation stridor, suspected tracheobronchomalacia
Recommended: Dynamic (paired inspiratory + expiratory) CT Chest is the preferred imaging study for adult expiratory wheezing or post-extubation stridor, suspected tracheobronchomalacia. Tracheal collapse > 50% on expiration is diagnostic.
Recommended study
Dynamic (paired inspiratory + expiratory) CT Chest
Tracheal collapse > 50% on expiration is diagnostic. Often associated with COPD, post-intubation, GERD.
If the default doesn't apply
Bronchoscopy preferred / available
Dynamic bronchoscopy
No contrast
Watch-outs
Excessive dynamic airway collapse (EDAC)
Different from tracheomalacia — anterior wall buckles inward; treatment differs (CPAP often helps).
Pearls
- Crescent / lunate / 'frown' deformity of trachea on expiratory CT is suggestive.
- Quantitative threshold: > 50% reduction in cross-sectional area on dynamic CT.
- Treatment: CPAP first-line; tracheoplasty or stenting in severe cases.