Prevalence of Central Airway Anatomical Variations and Structural Abnormalities Using Virtual Bronchoscopy: A...

Introduction Virtual bronchoscopy (VB) is an imaging technique that does not involve surgery or other invasive procedures. It is an imaging technique that reconstructs a three-dimensional image of the airways from computed tomography (CT) scans. It has been found to be a possible substitute for conventional bronchoscopy to assess airway abnormalities without the drawbacks of invasive bronchoscopy. This study aimed to evaluate the feasibility of VB in detecting airway abnormalities and to establish the incidence of anatomical variations in the airways of a tertiary care centre. Methods A retrospective study evaluated adult patients who had undergone CT thorax over a period of six months. The airway abnormalities of the pulmonary CT were detected using Picture Archiving and Communication System (PACS). Patients under 18 years of age were excluded, along with those with poor-quality CT images. The GE ADW 4.7 workstation software was used to reconstruct the Digital Imaging and Communications in Medicine (DICOM) images into three-dimensional (3D) virtual bronchoscopic images. Patient demographics and airway abnormalities were analyzed using descriptive statistics. Results Of the 225 patients undergoing a CT scan of the thorax, 22 patients had abnormalities of the airways. Tracheal diverticulum was the most common abnormality, followed by tracheal stenosis and tracheomalacia. Other less common findings were tracheal bronchus, saber-sheath trachea, tracheoesophageal fistula, and Mounier-Kuhn syndrome. The airway anatomy was accurately reconstructed and detailed views of the site and size of the abnormalities could be performed using VB. It also showed promise for pre-procedural planning for assessment of the airway beyond stenotic segments. Conclusions CT-based VB is a valuable noninvasive imaging modality for evaluating central airway anatomy and identifying anatomic variations and structural abnormalities. It provides high-quality 3D visualization of the tracheobronchial tree, which may assist in airway assessment and pre-procedural planning. The findings of this study provide baseline data on the prevalence of central airway anatomic variations and structural abnormalities in patients from a tertiary care center and support the complementary role of VB in clinical practice.