Imaging Evaluation of Laryngotracheal Stenosis

Laryngotracheal stenosis (LTS) encompasses any airway-narrowing condition at the glottis, supraglottis, subglottis, or trachea. Stenosis in this critical area represents a challenge in clinical practice due to the variety of possible causes and the complexity of therapeutic management. Diagnostic modalities such as endoscopy and imaging techniques have the potential to demonstrate the severity of stenosis and guide treatment. An individualized assessment is required in patients with LTS to determine the utility of these modalities. The primary imaging technique used is thin-section CT, which may be complemented with other imaging tools. Use of CT with multiplanar reconstruction and virtual endoscopy is highly accurate for detecting LTS. Multiple LTS classification systems have been developed to aid preoperative planning, predict outcomes and complications, and standardize descriptive reports. The role of radiologists in guiding treatment decisions through accurate assessment of the extent and characteristics of the airway stenosis is essential for effective clinical and surgical management. To comprehensively address LTS, the authors provide a structured journey that begins with a review of the main anatomic landmarks of the larynx and trachea. This is followed by a description of a radiologic diagnostic approach to LTS and a summary of measurement techniques and classifications. Finally, an overview of key imaging and clinical findings specific to conditions that may cause LTS is provided. ^©RSNA, 2025 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.