Investigation of Subcarinal Angle and Tracheobronchial Morphology in Patients with COVID 19: A Retrospective Computed Tomography Study

Abstract

Objective: Morphological features of the trachea are very important in choosing the correct endotracheal tube size for intubation. In this study, it was proposed to reveal the effect of SARS-CoV-2 on tracheobronchial morphology and subcarinal angle. Method: 56 (26 female, 30 male) COVID-19 and 48 (24 female, 24 male) healthy individuals aged 40 and over were included in the study. The mean age of female patients with COVID-19 was 51.30±12.78 years, while the women in the control group were 45.00±11.89 years. The mean age of male patients with COVID-19 was 48.73±13.99 years, while the mean age of men in the control group was 43.76±8.45 years. The trachea length (TL), proximal, middle and distal levels anteroposterior (AP) and transverse (TR) trachea diameters (TD), subcarinal angle (SA), proximal right main bronchus (RMB) and left main bronchus (LMB) diameters were also measured on computed tomography (CT) images. Results: The RMB angle was higher in men with COVID-19 than in the control group (p=0.005). TL was lower in women with COVID-19 than in the control group (p=0.030). Proximal AP-TD was higher in men with COVID-19 than in the control group (p=0.006). Proximal TR-TD was lower in men with COVID-19 than in the control group (p=0.029). TL, proximal, middle, and distal levels of AP and TR-TD,SA, RMB, and LMB angles, and proximal RMB and LMB diameters were found to be lower in women with COVID-19 than in men with COVID-19 (p=0.001). Conclusion: It was deduced that tracheobronchial morphology might change in patients infected with SARS-CoV-2.It is clinically important that this situation should not be overlooked, especially in the indication of endotracheal intubation.

Keywords

• COVID 19
• SARS-CoV-2
• Trachea
• Bronchi
• Subcarinal angle
• Morphology
• CT

COVID 19’lu Hastalarda Subkarinal Açı ve Trakeobronşiyal Morfolojinin İncelenmesi: Retrospektif Bilgisayarlı Tomografi Çalışması

Abstract

Amaç: Trakeanın morfolojik özellikleri, entübasyonda doğru endotrakeal tüp boyutunu seçmede oldukça önemlidir. Çalışmada SARS-CoV-2’nin trakeobronşiyal morfolojiye ve subkarinal açıya olan etkisinin ortaya konulması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 40 yaş ve üstü 56 (26 kadın, 30 erkek) COVID-19 ve 48 (24 kadın, 24 erkek) sağlıklı birey dahil edilmiştir. COVID-19'lu kadın hastaların yaş ortalaması 51,30±12,78 yıl iken, kontrol grubundaki kadınların yaş ortalaması 45,00±11,89 yıldır. COVID-19'lu erkek hastaların yaş ortalaması 48,73±13,99 yıl iken, kontrol grubundaki erkeklerin yaş ortalaması 43,76±8,45 yıldır. Bilgisayarlı tomografi (BT) görüntüleri üzerinde trakea uzunluğu (TU), proximal, orta ve distal seviyelerde anteroposterior (AP) ve transvers (TR) trakea çapları (TÇ), subkarinal açı (SA), proximalden bronkus prinsipalis dekster (BPD) ve sinister (BPS) çapları ayrıca açıları da ölçülmüştür. Bulgular: Çalışmaya katılan hasta ve kontrol grupları arasında her iki cinsiyette de yaş farkı istatistiksel olarak anlamlı değildi (kadınlarda p=0,051, erkeklerde p=0,126). BPD açısı COVID-19’lu erkeklerde kontrol grubuna göre daha yüksekti (p=0,005). TU COVID-19’lu kadınlarda kontrol grubuna göre daha düşüktü (p=0,030). Proksimal AP-TÇ COVID-19’lu erkeklerde kontrol grubuna göre daha yüksekti (p=0,006). Proksimal TR-TÇ COVID-19’lu erkeklerde kontrol grubuna göre daha düşüktü (p=0,029). TU, proksimal, orta ve distal seviyelerde AP ve TR-TÇ, SA, BPD ve BPS açıları, proksimalden ölçülen BPD ve BPS çapları COVID-19’lu kadınlarda COVID-19’lu erkeklerden daha düşük bulunmuştur (p=0,001). Sonuç: SARS-CoV-2 ile enfekte olan hastalarda trakeabronşiyal morfolojinin değişebileceği sonucuna varılmıştır. Özellikle endotrakeal entübasyon endikasyonunda bu durumun gözardı edilmemesi klinik olarak önemlidir.

Keywords

• COVID 19
• CT
• Bronkus
• Morfoloji
• SARS-CoV-2
• Subkarinal açı
• Trakea.

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