A saber-sheath trachea also known as scabbard trachea is a trachea that has an abnormal shape. This manifests as a narrowing of the portion of the trachea located within the thorax, and a widening of the diameter of the posterior area of the trachea. The lateral measurement of tracheal diameter decreases. In saber-sheath trachea, the inner wall of the trachea is smooth, there are no nodules or areas of thickening. [1]
The trachea is a cartilaginous and tubular structure which serves as the main airway, carrying air from the nose and mouth to the lungs. The total length is variable, and can range from 8-13 centimeters. The trachea's length spans both within the lung cavity, termed the intra-thoracic portion of the trachea, and outside the lung cavity, termed the extra-thoracic portion. [2] The intra-thoracic portion is typically 6-9 centimeters in length, while the extra-thoracic portion is 2-4 centimeters in length. The trachea is supported by C-shaped rings of cartilage, which supports the trachea and prevents it from collapsing during exhalation. [2] In men, a normal trachea will have a diameter measuring the distance from one side of the trachea to the other, termed the coronal diameter, of 13-25 millimeters, and in women the coronal diameter of a normal trachea will range from 10-21 millimeters. The diameter of the front side of the trachea to the back, termed the sagittal diameter, in men typically is from 13-27 millimeters and in women is 10-23 millimeters. [1]
It can occur in chronic obstructive pulmonary disease (COPD) or prolonged bilateral compression on it as in goitre. It is considered to be widely associated with COPD. During normal exhalation, the size of the trachea within the chest cavity becomes slightly smaller. This reduction is more noticeable for patients with COPD. [3]
The underlying process leading to the formation of the saber-sheath shape of the trachea is not fully understood. There are many currently suggested theories however, which include:
Diagnosing a patient with saber-sheath trachea is based on calculating a value called the tracheal index. The tracheal index is measured by taking the ratio of the width of the trachea and the depth of the trachea using cross-sectional imaging. [6] A tracheal index of 1.0 indicates that the trachea has a typical, appropriate rounded cross-section. A patient is considered to have saber-sheath trachea when the calculated tracheal index is below 0.67. [7]
On typical CT scans of the trachea, the normal appearance is oval, round, or horseshoe shaped. A saber-sheath trachea has distinct findings compared to normal tracheas on imaging, and may have additional features on CT besides intra-thoracic narrowing and widening diameter of the posterior portion. When cartilage becomes weak, as in saber-sheath trachea, CT scans can show the sides of the trachea curving inwards. This can be more apparent with forceful exhalation Moreover, the walls of the trachea within the thorax can also show slight thickening on CT. Another finding that can be seen is the hardening and becoming more bone-like of the cartilaginous rings in the trachea, a process called ossification. [8]
The respiratory system is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies greatly, depending on the size of the organism, the environment in which it lives and its evolutionary history. In land animals, the respiratory surface is internalized as linings of the lungs. Gas exchange in the lungs occurs in millions of small air sacs; in mammals and reptiles, these are called alveoli, and in birds, they are known as atria. These microscopic air sacs have a very rich blood supply, thus bringing the air into close contact with the blood. These air sacs communicate with the external environment via a system of airways, or hollow tubes, of which the largest is the trachea, which branches in the middle of the chest into the two main bronchi. These enter the lungs where they branch into progressively narrower secondary and tertiary bronchi that branch into numerous smaller tubes, the bronchioles. In birds, the bronchioles are termed parabronchi. It is the bronchioles, or parabronchi that generally open into the microscopic alveoli in mammals and atria in birds. Air has to be pumped from the environment into the alveoli or atria by the process of breathing which involves the muscles of respiration.
The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals lungs. The trachea extends from the larynx and branches into the two primary bronchi. At the top of the trachea, the cricoid cartilage attaches it to the larynx. The trachea is formed by a number of horseshoe-shaped rings, joined together vertically by overlying ligaments, and by the trachealis muscle at their ends. The epiglottis closes the opening to the larynx during swallowing.
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.
The thorax or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen.
Mechanical ventilation or assisted ventilation is the medical term for using a ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, with the main goal of helping the delivery of oxygen and removal of carbon dioxide. Mechanical ventilation is used for many reasons, including to protect the airway due to mechanical or neurologic cause, to ensure adequate oxygenation, or to remove excess carbon dioxide from the lungs. Various healthcare providers are involved with the use of mechanical ventilation and people who require ventilators are typically monitored in an intensive care unit.
The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.
A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi to branch from the trachea at the carina are the right main bronchus and the left main bronchus. These are the widest bronchi, and enter the right lung, and the left lung at each hilum. The main bronchi branch into narrower secondary bronchi or lobar bronchi, and these branch into narrower tertiary bronchi or segmental bronchi. Further divisions of the segmental bronchi are known as fourth order, fifth order, and sixth order segmental bronchi, or grouped together as subsegmental bronchi. The bronchi, when too narrow to be supported by cartilage, are known as bronchioles. No gas exchange takes place in the bronchi.
Exhalation is the flow of the breath out of an organism. In animals, it is the movement of air from the lungs out of the airways, to the external environment during breathing. This happens due to elastic properties of the lungs, as well as the internal intercostal muscles which lower the rib cage and decrease thoracic volume. As the thoracic diaphragm relaxes during exhalation it causes the tissue it has depressed to rise superiorly and put pressure on the lungs to expel the air. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles generate abdominal and thoracic pressure, which forces air out of the lungs.
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
The mediastinum is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is a region that contains vital organs and structures within the thorax, namely the heart and its vessels, the esophagus, the trachea, the vagus, phrenic and cardiac nerves, the thoracic duct, the thymus and the lymph nodes of the central chest.
Synovial osteochondromatosis (SOC) (synonyms include synovial chondromatosis, primary synovial chondromatosis, synovial chondrometaplasia) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. In most occurrences, there is only one joint affected, either the knee, the hip, or the elbow. Rarely involves the TMJ.
In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.
Tracheal collapse in dogs is a condition characterized by incomplete formation or weakening of the cartilaginous rings of the trachea resulting in flattening of the trachea. It can be congenital or acquired, and extrathoracic or intrathoracic. Tracheal collapse is a dynamic condition. Collapse of the cervical trachea or extrathoracic occurs during inspiration; collapse of the thoracic trachea or intrathoracic occurs during expiration. Tracheal collapse is most commonly found in small dog breeds, including the Chihuahua, Pomeranian, Toy Poodle, Shih Tzu, Lhasa Apso, Maltese, Pug, and Yorkshire Terrier.
The carina of trachea is a ridge of cartilage at the base of the trachea separating the openings of the left and right main bronchi.
Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible optical fiber instruments with realtime video equipment.
Obstructive lung disease is a category of respiratory disease characterized by airway obstruction. Many obstructive diseases of the lung result from narrowing (obstruction) of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself. It is generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems exhaling, and frequent medical clinic visits and hospitalizations. Types of obstructive lung disease include asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD). Although COPD shares similar characteristics with all other obstructive lung diseases, such as the signs of coughing and wheezing, they are distinct conditions in terms of disease onset, frequency of symptoms, and reversibility of airway obstruction. Cystic fibrosis is also sometimes included in obstructive pulmonary disease.
Tracheobronchial injury is damage to the tracheobronchial tree. It can result from blunt or penetrating trauma to the neck or chest, inhalation of harmful fumes or smoke, or aspiration of liquids or objects.
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD 2024 defined COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.
Tracheobronchomalacia (TBM) is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse. This condition can also affect the bronchi. There are two forms of this condition: primary TBM and secondary TBM. Primary TBM is congenital and starts as early as birth. It is mainly linked to genetic causes. Secondary TBM is acquired and starts in adulthood. It is mainly developed after an accident or chronic inflammation.
Emphysema is any air-filled enlargement in the body's tissues. Most commonly emphysema refers to the permanent enlargement of air spaces (alveoli) in the lungs, and is also known as pulmonary emphysema.