Endotracheal and tracheostomy tube-related complications: imaging with three-dimensional spiral computed tomography

Aim: To present our experience from the use of three-dimensional (3D) spiral computed tomography (CT) reconstructions for the detection of endotracheal and tracheostomy tube-related complications.

Material and methods: The CT-scans of thirteen patients who were subjected to spiral computed tomography for the evaluation of possible tracheal complications due to the use of endotracheal or tracheostomy tubes were retrospectively studied. In each case, a spiral scan of the airways from the larynx to the main bronchi was performed. Axial images were reconstructed with the use of the following three-dimensional visualization methods: volume rendering (VR), tissue transition projection (TTP), shaded surface display (SSD) and virtual endoscopy (VE). Detected complications were subdivided into acute and late, according to the time of appearance (during presence of tracheal tube or after its removal, respectively).

Results: Six patients showed acute complications (wrong placement of the tube with compression of tracheal wall in three cases, perforation of tracheal wall in two cases, tracheal stenosis in one case). Seven patients showed late complications (tracheal stenosis in all cases). Three-dimensional reformatted images contributed significantly to the detection of both acute complications (position of tube in relation to tracheal wall), and late complications (number, position, length and degree of stenoses), providing a non-invasive evaluation of the outer tracheal wall and tracheal lumen.

Conclusion: Three-dimensional spiral CT reconstructions are a valuable adjunct of transverse images for the evaluation of trachea in cases of suspected tracheal tube-related complications.