Postsurgical Change in the Tracheal Bifurcation Angle after Upper Lobectomy
Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanisi-ku, Kitakyushu-shi 807-8555, Japan. Academic Radiology
(Impact Factor: 1.75).
06/2003; 10(6):644-9. DOI: 10.1016/S1076-6332(03)80083-1
The purpose of this study was to evaluate postsurgical changes in the tracheal bifurcation angle on chest radiographs after upper lobectomy and to determine whether bronchial repositioning after upper lobectomy mimics that in upper lobe collapse.
The authors selected 81 patients who had undergone upper lobectomy with complete mediastinal and subcarinal lymph node dissection and in whom chest radiographs had been obtained before operation and at four postoperative intervals. The interbronchial angle and the subcarinal angle were measured on the preoperative and postoperative radiographs and compared statistically.
The average interbronchial angle and subcarinal angle during any postoperative period were significantly smaller than those before lobectomy (P < .001). These average angles decreased gradually during the postoperative periods.
The tracheal bifurcation angle was decreased on follow-up chest radiographs in most patients who underwent upper lobectomy with mediastinal lymph node dissection. This finding may be useful for establishing a history of this surgical procedure on the basis of chest radiographs.
Available from: Adam Kosiński
- "The tracheal bifurcation angle may be widened due to cardiac disease (left atrial enlargement, cardiomegaly, and pericardial effusion) and mediastinal abnormalities (subcarinal masses) [12,17,25]. However, the angle of tracheal bifurcation may be reduced after pulmonary lobectomy and lobar collapse . Furthermore, there was a weak inverse correlation between the shape of thorax and the tracheal bifurcation angle [17,25,26]. "
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Both the advancement of visual techniques and intensive progress in perinatal medicine result in performing airway management in the fetus and neonate affected by life-threatening malformations. This study aimed to examine the 3 tracheo-bronchial angles, including the right and left bronchial angles, and the interbronchial angle, in the fetus at various gestational ages.
Using methods of anatomical dissection, digital image analysis with an adequate program (NIS-Elements BR 3.0, Nikon), and statistics, values of the two bronchial angles and their sum as the interbronchial angle were semi-automatically measured in 73 human fetuses at the age of 14–25 weeks, derived from spontaneous abortions and stillbirths.
No male-female differences between the parameters studied were found. The 3 fetal tracheo-bronchial angles were found to be independent of age. The right bronchial angle ranged from 11.4° to 41.8°, and averaged 26.9±7.0° for the whole analyzed sample. The values of left bronchial angle varied from 24.8° to 64.8°, with the overall mean of 46.2±8.0°. As a consequence, the interbronchial angle totalled 36.2–96.6°, and averaged 73.1±12.7°.
The tracheo-bronchial angles change independently of sex and fetal age. The left bronchial angle is wider than the right one. Values of the 3 tracheo-bronchial angles are unpredictable since their regression curves of best fit with relation to fetal age cannot be modelled. Both of the 2 bronchial angles and the interbronchial angle are of great relevance in the location of inhaled foreign bodies, and in the diagnosis cardiac diseases and mediastinal abnormalities.
Available from: bjr.birjournals.org
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ABSTRACT: The aim of this study was to investigate the effect of body habitus, dimensions of the thoracic cavity, location of the carina within the mediastinum, and left atrial size on tracheal carinal angle using CT scan. The study population was drawn from the patients referred to CT scan for various indications. A total of 120 patients (65 men and 55 women; age range 17-85 years; mean age 56 years) who denied a history of prior thoracic surgery, and in whom CT scan excluded pulmonary fibrosis, moderate or severe emphysema, atelectasis, intrathoracic mass or adenopathy, pericardial or pleural effusion were prospectively enrolled. The interbronchial (IBA) and subcarinal (SCA) angles were measured on coronal reformatted images. The presternal and retrovertebral fat thickness, the anteroposterior and transverse diameters of the thorax, the distances from carina to the sternum and to the vertebral column were obtained at the level of carina. Three orthogonal dimensions and the volume of the left atrium were also assessed. The mean interbronchial angle was 77 degrees +/-13 degrees (range 49-109 degrees ) and subcarinal angle was 73 degrees +/-16 degrees (range 34-107 degrees ). IBA positively correlated with the female gender (r=0.25, p=0.007), body mass index (r=0.28, p=0.002), presternal (r=0.40, p=0.001) and retrovertebral fat thickness (r=0.31, p=0.001). The interbronchial angle was significantly greater in obese patients compared with lean patients (p=0.02). Both IBA and SCA were positively correlated with the left atrial volume (r=0.40, p=0.001 and r=0.34, p=0.001, respectively), and its transverse and craniocaudal dimensions. The carina-vertebral column distance inversely correlated with IBA (r=-0.42, p=0.001) and SCA (r=-0.41, p=0.001). The size of the thoracic cavity did not show significant relation to tracheal bifurcation angle. Tracheal bifurcation angle ranges widely in normal subjects, and absolute measurements of the carinal angle is of little diagnostic value. In addition to left atrial enlargement, female gender, obesity and close situs of carina relative to vertebral column are associated with greater tracheal bifurcation angle.
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ABSTRACT: To provide a quantitative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy.
In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization.
There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6).
There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.
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