Purpose or Case Report: CT with 4D cine imaging can non-invasively and dynamically characterize airways for various pathologies, such as airway caliber fluctuations in tracheobronchomalacia, intermittent compression by cardiovascular or other mediastinal structures, or constriction from anatomic anomalies like those associated with craniofacial syndromes. However, optimal interpretation of dynamic airway CT studies requires an understanding of the impact of such extrinsic factors as the presence of support apparatus (e.g., endotracheal tube, enteric tube), level of required respiratory support (e.g., positive end-expiratory pressure), and differences in positioning (e.g., with jaw thrust). We have performed more than 100 pediatric cases of dynamic airway CT under a variety of conditions, in patients who range from free-breathing to ventilator-dependent, and for a variety of pathologies. In this educational exhibit, we will consider how to balance and tailor extrinsic factors when using dynamic CT for the guidance of airway management, in order to meet diagnostic considerations and supplement other cardiopulmonary investigations, including cases with bronchoscopic and surgical correlates.
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