Pnömomediastinumlu hastalarda bilgisayarlı tomografide trakeobronşiyal açıların değerlendirilmesi

Abstract

Amaç: Pnömomediastinumlu hastalarda bilgisayarlı tomografide (BT) trakeobronşiyal çapları ve trakeobronşiyal bifurkasyon açılarını araştırmak. Gereç ve yöntem: Hastanemizin Radyoloji Arşivinde, pnömomediastinumlu (PP) 63 hasta ve normal BT bulguları olan (PN) 63 hastanın BT taramaları retrospektif olarak değerlendirildi. Pnömomediastinumlu hastalarda, BT görüntülerindeki mediastinal hava miktarı görsel olarak üç dereceye ayrıldı. Tüm hastalarda BT görüntülerinde torasik anteroposterior mesafe (TAPD) ve transvers torasik mesafe (TTD), trakea ve bronşların anteroposterior (AP) çapları, trakea uzunluğu (TL), sağ ana bronş açısı (RMBA), sol ana bronş açısı (LMBA), subkarinal açı (SCA) ve interbronşiyal açı (IBA) ölçüldü. Tüm ölçümler pnömomediastinumlu ve pnömomediastinumsuz hastalar arasında karşılaştırıldı. Bulgular: PN grubunda torasik AP çapı ve sol ana bronş çapında cinsiyete bağlı anlamlı bir fark gözlendi. Pnömomediastinumlu hastalar arasında %22,2'si (n=14) 1. derece, %30,2'si (n=19) 2. derece ve %47,6'sı (n=30) 3. dereceydi. PN hastalarında trakea uzunluğu ve sol ana bronş çapı, PP hastalarına göre daha yüksekti. PP grubunda ortalama SCA 75,06±23,40° idi ve PN grubuna göre anlamlı derecede daha büyüktü (p=0,001). LMBA, PN grubunda PP grubuna göre anlamlı derecede daha yüksekti (p=0,003). Sonuç: Daha dar LMBA, daha kısa trakea uzunluğu, daha büyük torasik AP çapı ve daha geniş SCA'ya sahip bireyler, barotravma durumunda pnömomediastinum gelişme riski daha yüksek olabilir.

Keywords

• Pnömomediastinum
• subkarinal açı
• trakea
• bronşlar
• bilgisayarlı tomografi

Supporting Institution

yok

Ethical Statement

Pamukkale Üniversitesi Tıp Fakültesi Etik Kurulu (02/22/2024, E-60116787-020-494146).

Thanks

yok

Evaluation of tracheobronchial angles on computed tomography in patients with pneumomediastinum

Abstract

Purpose: To investigate tracheobronchial diameters and tracheobronchial bifurcation angles on computed tomography (CT) in patients with pneumomediastinum. Materials and methods: CT scans of 63 patients with pneumomediastinum (PP) and 63 patients with normal CT findings (PN) were retrospectively evaluated in the Radiology Archives of our hospital. In PP, the extent of mediastinal air on CT images was visually classified into three grades. Thoracic anteroposterior distance (TAPD) and transverse thoracic distance (TTD), anteroposterior (AP) diameters of the trachea and bronchi, tracheal length (TL), right main bronchus angle (RMBA), left main bronchus angle (LMBA), subcarinal angle (SCA), and interbronchial angle (IBA) were measured on CT images in all patients. All measurements were compared between patients with and without pneumomediastinum. Results: A significant sex-related difference was observed in thoracic AP diameter and left main bronchus diameter in the PN group. Among PP, 22.2% (n=14) were grade 1, 30.2% (n=19) were grade 2, and 47.6% (n=30) were grade 3. Tracheal length and left main bronchus diameter were higher in PN patients compared to PP patients. The mean SCA was 75.06±23.40° in the PP group and was significantly greater than in the PN group (p=0.001). LMBA was significantly higher in the PN group compared with the PP group (p=0.003). Conclusion: Individuals with a narrower LMBA, shorter tracheal length, larger thoracic AP diameter, and wider SCA may be at greater risk of developing pneumomediastinum in the setting of barotrauma.

Keywords

• Pneumomediastinum
• subcarinal angle
• trachea
• bronchi
• computed tomography

Supporting Institution

none

Ethical Statement

Ethics committee of Pamukkale University Faculty of Medicine (02/22/2024, E-60116787-020-494146).

Thanks

none

References

1. Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci. 2013;5(8):460-466. doi:10.4103/1947-2714.117296
2. Işık NI, Kurtoglu Celik G, Işık B. Evaluating emergency department visits for spontaneous and traumatic pneumomediastinum: a retrospective analysis. Ulus Travma Acil Cerrahi Derg. 2024;30(2):107-113. doi:10.14744/tjtes.2024.66059
3. Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: overview and appearance on computed tomography. World J Radiol. 2014;6(11):850-854. doi:10.4329/wjr.v6.i11.850
4. Magouliotis DE, Sgantzou I, Salemis NS, et al. Pneumomediastinum: experience with 87 patients. Acta Med Acad. 2023;52(2):88-94. doi:10.5644/ama2006-124.408
5. Chouliaras K, Bench E, Talving P, et al. Pneumomediastinum following blunt trauma: worth an exhaustive workup? J Trauma Acute Care Surg. 2015;79(2):188-192. doi:10.1097/TA.0000000000000714
6. Onoe R, Yamashiro T, Handa H, et al. 3D-measurement of tracheobronchial angles on inspiratory and expiratory chest CT in COPD: respiratory changes and correlation with airflow limitation. Int J Chron Obstruct Pulmon Dis. 2018;13:2399-2407. doi:10.2147/COPD.S165824
7. Herek D, Herek O, Ufuk F. Tracheobronchial angle measurements in children: an anthropometric retrospective study with multislice computed tomography. Clin Exp Otorhinolaryngol. 2017;10(2):188-192. doi:10.21053/ceo.2016.00185
8. Fernandes SF, Pradhan A. Estimation of subcarinal angle using minimum intensity projection in computed tomography. Asian J Pharm Clin Res. 2018;11:383-385.

9. Parry AH, Wani AH, Shiekh Y, Gojwari TA. Determination of subcarinal angle of trachea using computed tomography. Int J Res Med Sci. 2019;7:1527-1532.
10. Mi W, Zhang C, Wang H, et al. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS One. 2015;10(4):e0123177. doi:10.1371/journal.pone.0123177
11. Ruan Y, Xue H, Cao W, et al. Impact of cardiac factors on central airway anatomical parameters in patients undergoing lung mass surgery. J Cardiothorac Surg. 2025;20(1):35. doi:10.1186/s13019-024-03277-7
12. Karabulut N. CT assessment of tracheal carinal angle and its determinants. Br J Radiol. 2005;78(933):787-790. doi:10.1259/bjr/75107416
13. Kahraman Ş, Yazar MF, Aydemir H, Kantarci M, Aydin S. Detection of tracheal branching with computerized tomography: the relationship between the angles and age-gender. World J Radiol. 2023;15(4):118-126. doi:10.4329/wjr.v15.i4.118
14. Khade B, Waheed AR, Yadav N, Diwan CV. Study of subcarinal angle of human trachea by computerized tomography. Int J Anat Res. 2016;4:2828-2832. doi:10.16965/ijar.2016.346
15. Ulusoy M, Uysal II, Kıvrak AS, et al. Age and gender related changes in bronchial tree: a morphometric study with multidetector CT. Eur Rev Med Pharmacol Sci. 2016;20(16):3351-3357.
16. Wani TM, Buchh B, AlGhamdi FS, et al. Tracheobronchial angles in children: three-dimensional computed tomography-based measurements. Paediatr Anaesth. 2018;28(5):463-467. doi:10.1111/pan.13377
17. Matsuoka S, Shimizu K, Koike S, et al. Significance of the evaluation of tracheal length using a three-dimensional imaging workstation. J Thorac Dis. 2022;14(11):4276-4284. doi:10.21037/jtd-22-595
18. Adhikari P, Gupta C, Prakashini K, et al. Anatomic reference measures for central airway anatomy in Indian adults: implications for precision airway management in surgical patient safety. Patient Saf Surg. 2025;19(1):26. doi:10.1186/s13037-025-00450-2