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Radiological evaluation of post-tracheostomy lesions
  1. Alexander S. Macmillan,
  2. A. Everette James, Jr.,
  3. Frederick P. Stitik,
  4. Hermes C. Grillo
  1. Departments of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass.
  2. Johns Hopkins Hospital, Baltimore, Maryland
  3. Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass., U.S.A.

    Abstract

    Post-tracheostomy lesions are becoming more commonplace and surgical techniques for definitive repair of these abnormalities are being developed. These lesions, in general, occur at two sites, the proximal lesions at the tracheostomy incision and the distal lesions 1·5 to 2·5 cm inferior in the area of the tracheostomy balloon cuff. Granuloma formation, stenosis, tracheomalacia, and perforation of the tracheal wall have been encountered in our experience. Clinical symptoms depend upon the type and location of the lesion as well as on the patient's awareness and physical activity. Radiological evaluation offers an accurate method to depict the anatomical and physiological alterations. This radiological assessment should begin with routine postero-anterior and lateral chest radiographs followed by fluoroscopy. Laminograms and special oblique views are often helpful. Contrast tracheograms using powdered tantalum allow good mucosal detail as well as excellent delineation of structural and physiological abnormalities.

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