Cinematic CT as a valuable protocol for severe ECAC

Expiratory central airway collapse (ECAC) is a pathology gaining recognition in the medical community due to its unspecific symptoms and diagnostic challenges. Its current gold standard for diagnosis, dynamic bronchoscopy, is invasive. Current non-invasive techniques such as computed tomography (CT) protocols have shown limited reproducibility. We present a case of a 77-year-old man with suspected ECAC who underwent evaluation with two different expiratory CT protocols. The initial standard end-expiratory CT could not detect airway collapsibility. However, dynamic bronchoscopy detected severe ECAC. Afterwards, we implemented a novel CT protocol, called dynamic forced expiratory CT (cinematic), comprising detailed, consecutive helical imaging of the central airway throughout the entire respiratory cycle, detecting severe ECAC, as proven by the earlier dynamic bronchoscopy. We hypothesize this may reduce the risks and need for performing multiple invasive procedures such as dynamic bronchoscopy. Extensive studies are required to evaluate the feasibility of its implementation for diagnosing ECAC.