Trachea
The trachea, or windpipe in layman’s terminology, begins on its upper end just below the larynx and extends inferiorly into the chest where it splits into the right and left mainstem bronchi; delivering inspired air to the right and left lungs, respectively.
The tracheal rings comprise approximately two-thirds of the circumference of the trachea, anteriorly and laterally. The remaining posterior one-third “membranous” tracheal mucosa is the anterior surface of the “party wall” it shares with the esophagus.
Photo Examples
Trachea (1 of 2)
View from just below the vocal cords. Note the u-shaped cartilaginous tracheal rings that give the trachea some firmness and resistance to collapse. The membranous third of the circumference puts a flat “lid” on the trachea, but can bulge inward when a person coughs.
Tracheal rings (2 of 2)
View from the middle of the trachea in a different patient. Here the tracheal rings are shaped more like an “o” but the top of the “o” is completed by the membranous tracheal wall marked by the blue line. Also, the carina is seen distally and marked by an “x”. This is where the trachea divides into right and left mainstem bronchi.
Tracheal Deformity After Tracheotomy
This man had a grave and life-threatening illness that required mechanical ventilation in an ICU for about 3 months. The initial weeks were through an oro-tracheal tube (a tube placed through the mouth, between the vocal cords, and into the trachea); the remaining 2 ½ months were via a tracheotomy (breathing tube inserted through the base of the neck directly into the trachea). Now out of hospital for many months, he has a barking cough, and occasionally mild harsh inspiratory noise.
No breathing tube damage on the vocal cords (1 of 5)
First of all, we see that the initial oro-tracheal breathing tube did not do visible damage at the level of the vocal cords. And this correlates with his essentially normal voice.
Airway is narrowed below vocal cords (2 of 5)
Viewing from immediately below the vocal cords, it appears that the airway is exceedingly narrowed. That is because we are looking “in line” but the trachea takes a sharp bend. Air of course does not mind traveling in curves, and this explains why the patient is breathing better than this “in-line” photo might suggest.
Deformed airway (3 of 5)
Viewing a little closer, one can see that the airway lumen is bigger than it appears, but just deformed and deviated.
distinctly narrowed but not marginal airway (4 of 5)
Even closer, showing a distinctly narrowed but not marginal airway, explaining why this man chose not to undergo tracheal resection and repair.
Carina is normal (5 of 5)
The distal-chip scope is passed through the area of stenosis. This man is aware that airway is further narrowed by this sharing with the scope, but he is not “panicked” as he would be momentarily if his airway were truly marginal.
In a case like this, it is crucial to make sure that there isn’t a second area of narrowing; here there is not as distal trachea to the carina (C) is normal.
Trachea, with Tracheotomy Tube
Trachea, with tracheotomy tube (1 of 2)
Upper trachea, with tracheotomy tube in view.
Trachea, with tracheotomy tube (2 of 2)
When the patient exhales fully, the posterior (back-side) tracheoesophageal party wall flexes anteriorly (frontward) to obstruct the trachea just above tracheotomy tube entry.
Benign Bony Growths in the Trachea
View into mid-trachea, diagnosis unknown (1 of 4)
View into the middle of the trachea in a man being evaluated for an unrelated problem. Note the remarkable projections (compare with normal trachea elsewhere on site). At initial examination the diagnosis was not known. The ‘X’ in subsequent photos marks the same place on the carina.
Spicules found in the tracheal wall (2 of 4)
A little farther down the trachea, and a closer view of the spicules projecting from the tracheal wall, whose nature at this examination was still unknown.
Diagnosis revealed (3 of 4)
View within the trachea just above the carina, where the trachea divides into right and left mainstem bronchi. Attempted biopsy revealed the extremely hard and unyielding nature of the projections, subsequently shown to be “bone.” Literature review revealed the diagnosis of tracheobronchopathia osteochochondroplastica, which essentially means “disease in trachea and bronchi due to bony change/ growth in cartilage rings.”
Biopsy reveals bone tissue (4 of 4)
Attempt to biopsy these projections with a flexible scope was unsuccessful due to their bony nature. Biopsy in the operating room made the diagnosis by revealing bone tissue. Copy and paste the link below to view the definition of tracheobronchopathia osteochochondroplastica: http://www.ncbi.nlm.nih.gov/pubmed/25013916
Tumor in Trachea
Biopsy (1 of 4)
Tumor growing through wall of trachea, from a paratracheal lymph node. Biopsy forceps are about to close to take a tissue fragment for study.
After biopsy (2 of 4)
After biopsy was taken at arrow. The result: squamous cell carcinoma thought to be an unusual metastasis from unusually aggressive larynx cancer.
Tumor gone (3 of 4)
Soon after radiation therapy, the tumor has melted away, leaving a depression in the tracheal wall.
Slow return (4 of 4)
Eighteen months later, the patient has experienced a fairly durable response, with very slow return of tumor.
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