SPHP

INDICATION:  Tracheomalacia, bronchomalacia, tracheobronchomalacia

• 3mm Axial Soft Tissue Inspiratory
• 1mm Axial Lung Inspiratory
• 1mm Axial Lung Expiratory
• 3mm Coronal Lung Inspiratory
• 3mm Sagittal Lung Inspiratory
• 2mm Oblique Axial (mainstem bronchi) Lung Inspiratory and Expiratory
• Coronal MIP lung
  

NOTES:               This study is performed during end-inspiration and dynamic expiration.  For the dynamic expiration scan, the patients should be coached prior to the scan and instructed to “take a deep breath in and to blow it out” during the CT acquisition. The patient should NOT “purse” their lips.  A disopasble mouthpiece would help in preventing the patient from “pursing” their lips. The patient should perform a “practice run” to confirm that the he/she understands the instructions and that the patient is able to perform the forced expiration thru out the duration of the scan. The timing is crucial. The CT scan should begin simultaneously with the onset of the patient’s expiratory effort. It is very important that scan is started once the patient begins the expiration and that the patient continues the forced expiration thru out the scan.  Otherwise, the study will result in false negative studies.

The study does not require intravenous contrast unless there is another indication that requires intravenous contrast.  The contrast-enhanced study should be performed during the end-inspiratory phase.

Area measurement of the lumen of the trachea and bronchi should be made with a freehand ROI for both phases.  The location of the measurements are as follows:

trachea 1 cm above the aortic arch

trachea 1 cm above the carina

the area of maximal narrowing

proximal right mainstem bronchus

proximal left mainstem bronchus