Imaging of therapeutic airway interventions in thoracic oncology

• Published in: Clinical radiology 2022-01, Vol.77 (1), p.58-72
• Main Authors: Godoy, M.C.B., Truong, M.T., Jimenez, C.A., Shroff, G.S., Vlahos, I., Casal, R.F.
• Format: Article
• Language: English
• Subjects: Airway Obstruction - complications; Airway Obstruction - diagnostic imaging; Humans; Respiratory Tract Neoplasms - complications; Respiratory Tract Neoplasms - diagnostic imaging; Respiratory Tract Neoplasms - surgery; Tomography, X-Ray Computed - methods
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2021.09.012

Tracheobronchial obstruction, haemoptysis, and airway fistulas caused by airway involvement by primary or metastatic malignancies may result in dyspnoea, wheezing, stridor, hypoxaemia, and obstructive atelectasis or pneumonia, and can lead to life-threatening respiratory failure if untreated. Complex minimally invasive endobronchial interventions are being used increasingly to treat cancer patients with tracheobronchial conditions with curative or, most often, palliative intent, to improve symptoms and quality of life. The selection of the appropriate treatment strategy depends on multiple factors, including tumour characteristics, whether the lesion is predominately endobronchial, shows extrinsic compression, or a combination of both, the patient's clinical status, the urgency of the clinical scenario, physician expertise, and availability of tools. Pre-procedure multidetector computed tomography (MDCT) imaging can aid in the most appropriate selection of bronchoscopic treatment. Follow-up imaging is invaluable for the early recognition and management of any potential complication. This article reviews the most commonly used endobronchial procedures in the oncological setting and illustrates the role of MDCT in planning, assisting, and follow-up of endobronchial therapeutic procedures. •Airway obstruction, haemoptysis and fistulas can occur in the oncologic setting.•CT is useful to determine the cause, location, and extent of airway obstruction.•CT allows multiplanar reformat, minimum-intensity projection and volume rendering.•Interventions include mechanical debulking, thermal ablations and cryotherapy.•Complications include stent fracture and migration, obstruction, and infection.