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8/10/2019 Dimensiones de Traquea

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Fig . 1 -L eve l o f m ea su rem en t s olid lin e o f co ro na l (A ) an d sa g itta l (B )

trac he a l d ia m e te rs , 2 cm ab ov e p ro jec ted to p o f ao rtic a rch b roke n line .

90 4 B R E A T N A C H E T A L .

A JR :142 , M ay 198 4

w ere m a de o f th e a ir c o lu m n a lo ne , ex c lu d in g the trac hea l w a ll. T h is

lev e l w a s ch os en be ca us e o f th e h ig h v is ib il ity o f the ao rtic a rch o n

d ia gno st ic ch es t rad iog rap hs , w h ere as th e ca rin a is no t a lw a ys

p re c ise ly id en tif iab le . In te rn a l tra che a l d ia m e te rs w e re us ed fo r a ll

m e a s u r e m e n t s .

Resu l t s

T ra ch e a l d im e n s io n s w ere g ro u p e d a cco rd in g to th e su b -

je c ts a g e a n d g en d e r, a n d th e m e a n co ro n a l a n d s a g itta l

d ia m e te rs ( S D ) w e re c a lcu la te d fo r e a c h d e ca d e fo r m a le s

an d fe m a le s (ta b le i ). In m e n , a t a ll a g e s fro m 2 0 to 79 ye a rs ,

s ta tis tica lly s ig nifica nt d iffe re nce s p = 0 .05 ) w ere o b se rve d

be tw e e n s a g itta l a n d co ro n a l d ia m e te rs , th e fo rm e r b e in g

co n s is te n tly g re a te r th a n th e la tte r (fig s . 2 a n d 3 ). In w o m e n ,

a lth o u g h m e a n sa g itta l d ia m e te rs w e re g re a te r th a n co ro n a l

fro m th e th ird d e ca d e o n , th e d iffe re n ce w a s n o t as g re a t a s

in m en a n d a ssu m ed sta tis tica l s ig n ifica n c e p = 0.0 5 ) o n ly in

su b je c ts o ve r 4 9 ye a rs o f a g e . In th e th ird th ro u g h e ig h th

d e ca d e s o f life , th e c o ro n a l a n d s a g itta l d im e n s io n s w e re

g re a te r in m e n th a n in w o m e n ; th e d iffe re n ce s w e re s ta tis ti-

ca lly s ig n ifica n t (p = 0 .0 5 ). D u rin g the s e co n d d e ca d e , a l-

th o u g h th e m e a n va lu es in b o th d im en s io n s w e re gre a te r in

b o ys th a n in g irls , th e d iffe re n ce s be tw e e n th e g e n d e rs w e re

n o t s ta tis tica lly s ig n ifica n t ( fig . 4 ). G e n d e r d iffe re n ce s w e re

obse rved

in g row th p a tte rn s (fig s . 2 a n d 3 ): In m e n , b o th

d im e n s io n s in cre a se d ra th e r s h a rp ly d u rin g th e se co n d a n d

th ird d eca d es , the n m o re s lo w ly (b u t s ig n ifica n tly ) d u rin g the

fou rth de ca de ; in w o m en , g ro w th w a s m u ch m ore g rad u a l

fro m th e s e co n d thro u g h fo u rth d e c a de s . In n e ith e r g e n d e r

d id a n y c h a n g e o c cu r in e ith e r d im e n s io n fro m th e fo u rth

dec de on

R e la tio n s b e tw e e n tra ch e a l m e a su re m e n ts a n d b o d y

w e ig ht a n d h e ig h t w e re a n a ly ze d b y m u ltip le re g re ss io n te ch -

n iq u e s , in c lu d in g cro ss -v a lid a tion ; n o s ta tis tic a lly s ig n ifica n t

co rre la tio n w a s fo u n d .

Dis cuss ion

T h e m o s t co m m o n ly q u o te d fig ure s fo r tra c h e a l ca lib er in

no rm a l su b jec ts a re th o se o f K a tz e t a l. fi ], Je s se p h a n d

M e re n d in o [2 ], G re e n e [3 1 , a n d F ra se r a n d P a re [4 ]; d a ta fro m

th e se fo u r s tu d ie s a re su m m a rize d in tab le 2 . A lth o u g h v a lu e s

fo r n o rm a l ra n ge s a re qu o te d e lse w h e re [5 , 6 ], th e d a ta o n

w h ich th e fig u re s a re b a se d g e n e ra lly la c k s ta tis tica l va lid ity .

It ca n b e se e n fro m ta b le 2 th a t th e re is c o n s id e ra b le va ria tio n

in th e n o rm a l ra ng es pu b lish e d . G re en e

[3 ] m e a su re d th e

in te rn a l tra c he a l d ia m e te r 1 c m a b o ve th e a o rtic a rch , w h e re a s

Je s se p h a n d M e re n d in o [2 ] u s ed a p o in t ju s t p ro x im a l to th e

trac h e a l b ifu rca tio n . W e fo u n d a p o in t 2 cm a b o v e th e a o rtic

a rc h to b e m o re co n s is te n tly re p ro d u c ib le , th o u g h w e o b -

se rved

n o re a l v a ria tio n b e tw e e n m e a s ure m e n ts ta ke n a t

e ith e r le v e l. T h e re p o rte d d iffe re n ce s in n o rm a l ra n g e s p ro b -

a b ly re fle c t, a t lea s t in p a rt, d iffe re n ce s in a g e g ro u p s an d

g e n d e r p re d o m in a n c e a m o ng th e p o p u la tio n s s tu d ie d . In th e

p res en t s tud y , w e use d a la rge r g rou p o f p a tien ts w ith c on -

v in c in g n u m e ric re p re se n ta tio n fo r b oth g e n d e rs in e a ch d e c -

a d e fro m 1 0 to 7 9 ye a rs o f a g e . T h e sm a ll s iz e o f th e S D fo r

e a c h m e a n in o u r se r ie s in d ic a te s sa tis fa c to ry n u m e ric re p -

res e n ta tio n fo r e a ch d e ca d e o n a s ta tis tica l b a s is a n d th e

v a lid ity o f co m p a ra tive d a ta b e tw e e n th e g e n de rs . T h e in -

c re a se in c o ro n a l a n d sa g itta l tra c h e a l d im e n s io n s fo r b o th

g en d e rs u p to a g e 3 0 (fig . 4 ) is im p o rta n t in a sse s s in g n orm a l

v a lu e s fo r yo u n g e r p a tie n ts . T h e s im ila r ity b e tw e e n co ro n a l

a nd sa g itta l d ia m e te rs in th e se co n d d e ca d e in m a le s a n d in

the se co n d a n d th ird d e ca d e s in fe m a le s c o rre la te s w e ll w ith

the w o rk o f E n g le [7 ], w h o fo u n d th a t th e tra ch e a in ch ild re n

a nd yo u n g a d u lts is ro u g h ly c ircu la r in c ro s s se c tio n . In a ll

d ec a d e s a fte r a g e s 2 0 (m e n ) a n d 3 0 (w o m e n ), th e tra ch e a

a ssu m e s a m o re o vo id sh a p e in c ro s s se c tio n ; th e d iffe re nc e s

b etw e n co ro n a l a n d sa g itta l d ia m e te rs a re g re a te r in m e n

tha n in w o m en .

C h a n g e s in tra ch e a l d im e n s io n s o cc u r in a v a rie ty o f co n -

d itio n s ; fo r e x am ple , th e re is d ila ta tio n in tra ch e o b ro n ch o m e-

g a ly [1 , 8 ] (fig . 5 ) a n d tra c h e o m ala c ia [9 ] a n d n a rro w in g in

tra c h e ob ro n ch o p a th ia o s te o ch o n d ro p la s tic a [1 0 ], re la p s in g

po lyc ho nd ritis [1 1

1

f ib ros in g m ed ia s tin it is [12 , 1

3 ], rh in o -

sc le ro m a [i 4 ], a n d s a b e r sh e a th tra c h e a [1 5 ]. T h e la s t-

n am ed d e se rve s b rie f d e s crip tio n .

S a b e r-s h ea th tra ch e a , a s d e fin e d b y G re e n e a n d L e ch n e r

[1 5 ], in vo lv e s a co ro n a l tra ch e a l d ia m e te r le ss th a n tw o -th ird s

the sa g itta l d ia m e te r (fig . 6 ). In G re e n e s la te r re p o rt [3 ], th e

m e a n co ro n a l a n d sa g itta l d ia m e te rs in a co n tro l g ro u p (6 0

m e n ; m e a n a g e , 6 6 .4 ye a rs ) w e re i 9 .7 a n d 2 2 .5 m m , re sp e c -

tiv e ly , a n d in a s tu d y gro u p (6 0 m e n ; m e a n a g e , 6 3 .9 ye a rs )

1 2.0 a n d 2 5 .8 m m , re sp e c tive ly . S u ch a p ro n o u n ce d d iffe r-

e n ce b e tw e e n th e tw o d ia m e te rs w a s n o t s e e n in a n y o f o u r

pa tie n ts , in d ica tin g tha t s ab e r-she a th trac he a is n o t a n a tu ra l

co n seq u en ce o f a g in g , as w a s su gg e s ted by S im m o nd s

[1 6 ], c ite d b y G re e n e [3 ]. T h a t th e d e fo rm ity d o e s n ot o ccu r

in th e n o rm a l p o p u la tio n a t a n y a g e a d d s su p p o rt to G re e n e s

8/10/2019 Dimensiones de Traquea

3/4

22

20

18

16

14

12

10

Ma le s

es

10 -19 20 -29 30-39 40 -49 50-59 60 -69 70-79

2 4 6 8 2 22 2 4 2 6 2 8 3

Age in Years

20

e s

Ma le s

18

;

E

o

16

C

2 1 4 r

0

: 12

10 -19 20-29 30-39 40 -49 50-59 60 -69 70 -79

m o na ry d ise a s e w h e n o th e r co n v in c in g ra d io g ra p h ic e v id e n ce

is la ck ing , a nd it m ilita te s a ga in s t the e rro n eo us a ssu m p tion

th a t co ro n a l n a rro w in g is c au s e d b y a m e d ia s tin a l m a ss .

In o u r s tu d y , n o co rre la tio n w a s o b s e rv e d b e tw e e n tra ch e a l

d im e n s io n s a n d su b je c ts w e ig h t o r h e ig h t. T h is co n tra s ts

w ith th e re s u lts re p orte d b y F ra s e r a n d P a re [4 ] in a s tu dy o f

3 5 0 c h e s t ra d io g ra p h s o f ro u g h ly e q u a l n u m b e rs o f a s ym p -

to m a tic m e n a n d w o m e n 3 0 -8 0 ye a rs o f a g e ; th e se a u th o rs

fo u n d th a t sa g itta l tra c h e a l d ia m e te rs in cre a se d g ra d u a lly w ith

in cre a s ing h e ig h t, a lth o u g h n e ith er a g e n o r w e ig h t h a d a n y

a p p a re n t in flu e n c e . T he a ve ra g e s a g itta l d ia m e te r in c re a se d

fro m i 7 .6 m m in su b je c ts 5 0 -5 9 in ch e s ( i 2 7 - i 5 0 cm ) ta ll to

2 2 .5 m m in s ub je c ts 7 0 -7 2 inc h e s ( i 7 8 -i 8 3 cm ) ta ll; co rre -

sp o n d in g co ro n a l d im e n s io n s w e re n o t re co rd e d . W e h a ve n o

e xp lan a tio n for th e d is c re p a n c y b e tw e e n th e tw o s tu d ie s

re g a rd in g th e e ffe c t o f su b je c ts h e ig h t o n tra c h e a l d im e n -

s ions .

A ss u m in g a n o rm a tive ra ng e th a t e n co m p a ss e s th re e S D s

fro m th e m e a n , th e u p pe r lim its o f n o rm a l fo r co ro n a l a n d

sag itta l d ia m e te rs o f the tra ch ea l a ir c o lum n in m e n ag e d

20 -

7 9 a re 2 5 a n d 2 7 m m , res p e c tiv e ly ; in w o m e n a g e d 2 0 -7 9 ,

th e y a re 2 i a n d 2 3 m m , re s p e c tiv e ly . T h e lo w e r lim it o f n o rm a l

fo r b o th d im e n s io n s is 1 3 m m in m e n a n d i 0 m m in w o m e n .

A n y d e v ia tio n fro m th e s e fig u re s in d ica te s p ath o lo g ic w id e n -

in g o r n a rro w in g o f th e tra ch e a l a ir co lu m n .

A C K N O W L E D G M E N T

co n te n tio n [i 5 ] th a t it is a lm o st in v a ria b ly a s so c ia te d w ith

ch ro n ic o b s tru c tiv e a irw a y d ise a s e : O f th e 6 0 p a tie n ts w ith

sa b e r-sh e a th tra ch e a , 95 % ha d c lin ic a l e v id e n ce o f c h ro n ic

o b s tru c tiv e p u lm o n a ry d ise a s e, a s co m p a red w ith o n ly 1 8 %

in the co n tro l g ro u p . T h e va lu e o f th is ra d io g ra p h ic s ign is

tw o fo ld : It in d ica te s th e p re se n ce o f ch ro n ic o b s tru c tiv e p u l-

W e th an k S h aron C o m p ton fo r ass is ta nce w ith co m p u te r a na ly s is .

AJR:142 , M ay 1 98 4

N O R M A L T R A C H E A L D IM E N S IO N S

90 5

T A B LE 1 :

M ean C o rona l and Sag it ta l T rachea l D iam e te rs in No rm a l Sub jec ts b y G ende r and A ge

M a l e

F ema le

Ag e G ro up ( ye ar s)

N o. o f S ub te cts

Trachea l Diamete r (m m ): M ean S D

N o . o f S u bj ec ts

T ra ch ea l D ia me te r (

m m ): M e an

SD

Corona l Sag i t t o ron Sag i t t

1 0-19 26 1 5 .5 2 .8 1 5 .4 3 :1 2 2 1 4 .4 1 .6 14 .5 1 .3

20 -2 9 81 1 8 .7 2 .0

1 9 .3 2 .0 98 1 5 .7 1 .6 15 .6 1 .7

30 -39 72

19 .2 2 .1 1 9 .7 2 .4 64

1 6 .0 1 .8 16 .3 2 .3

40 -49 69 1 9 .5 2 .3 20 .3 2 .2 45 1 6 .6 2 .0

16 .8 2 .2

50 -59 80 1 9 .2 2 .3

20 .4 2 .6 65 1 6 .5 1 .6

1 7 .0 2 .0

6 0 -6 9 7 1 1 9 .5

2.2 2 0 .7

2 .5 48 1 6 .8 2 .0 1 7 .2 2 .3

70 -7 9 31 1 9 .7 2 .2 20 .8 1 .8

36 1 6 .4 2 .4 1 6 .5 2 .3

N ote -C oro na l a nd sa gitta l tra ch ea l d ia me te rs w ere d ef in ed a s th e in te ma l d ia me te rs

o f the trac hea l a ir co lum n

as m ea sured a t a

l eve l

2 c m a bov e

the p ro jec ted top

o f th e

a or tic a rc h

on poste roan te r io r

a n d l at er al r ad io g ra p hs , r es pe ct iv el y.

E

E

0

0

E

to

0

t

a,

to

C l)

to

0

A ge G roup

F ig . 2 .-M e an s ag itta l t rac he a l d iam ete rs (m m) in no rm al s ub jec ts by g en der

an d ag e g rou p (d eca de s).

A ge G roup

F ig . 3 .-M ean co ron a l trac hea l d iam ete rs (m m) in no rm al su b je c ts b y g en der

a nd a ge g ro up (d ec ad es ).

E

E

20

0

0

E 18

to

O 16

to

C

0

14

0

C . .) 1 2

C

10

F ig . 4 .-M e an co ro na l tra ch ea l d iam ete rs (m m) in n o rm a l sub jec ts b y ge nd er

an d a ge (ye a rs ) du ring sec on d d eca de o f life .

8/10/2019 Dimensiones de Traquea

4/4

A B A B

90 6

B R E A T N A C H E T A L .

A JR :14 2, M ay 1 98 4

T A B L E 2 : N o rm a l C o ro n a l a n d S a g itta l T ra ch e a l D iam e te rs

Repor ted

b y P rev io us In ves tig ato rs

Refe r enc e

N o . o f S u bj ec ts

(gende r )

A ge R an ge

(mean)

in Y ea rs

Trac hea l D iam ete r (m

m ): R ange (m ean

SD )

C orona l S ag a i

[1 ] 5 0 . . . 1 3 -2 5 (2 0 .2 3.4) ...

[2 )

2 1 (M )

2 6 (F )

1 3 -8 6

1 5 -2 7 (2 2 .0 2.6)

1 3 -2 5 (1 7 .0 2 .2 )

...

...

[3 ] 6 0 (M ) (6 6.4 ) 1 5 -2 6 (1 9 .7

2 .0 ) 1 8 -3 2 (2 2 .5

2.4)

[4 ] 1 75 (M )

1 7 5 (F )

3 0 -8 0

1 1

-2 6 (1 9 .5 )

9 -2 4 (1 5 .5 )

1 1 -3 0 (1 7.5 )

7 -2 6 (1 5 .5 )

F ig . 5 .-T rac he ob ro nch om ega ly (M oun ie r-K uh n syn dro me ). C oro na l d ia m-

e te r (A ,

s oli d lin e =

3 1 m m; sa g itta l d iam ete r (B ,

s olid li ne =

22 m m . B r oken

l ine

m arks le ve l o f top o f ao rtic a rch .)

R E F E R E N C E S

1 . K a tz I, L e V in e M , H e rm an P . T ra ch e o b ro n c h io m eg a ly : th e M ou n -

ie r-K uhn s yn dro me . A JR 1 96 2;88 : 1 08 4-10 94

2 . J e sse p h JE , M ere n d in o K A. D im en s io n a l in te rre la tio n sh ip s o f th e

m a jo r c o m p o n e n ts o f th e h u m a n tra ch e o b ro nc h ia l tre e . Su rg

G yne co l O bs te t 1 9 5 7 ;1 0 5

: 2 1 0 -2 14

3 . G ree ne A . S a be r-sh e a th tra che a : re la tio n to ch ron ic ob s tru c tive

pu lm on ary d is ea se .

A JR 1 9 7 8 ;1 3 0

: 4 4 1- 44 5

4 . F ra se r A G , P a re JA P .

D iagno s is o f d ise a ses o f th e ch es t,

vo l 1 .

P h ila de lph ia : S a und ers , 1 97 7 :

56

5 . S ch in z H A , B ae n sch W E , F ro m m h o ld W , G la un er A , U e h lin g e r

E , W ella u e r J .

R oe ntg en d ia gn os is ,

2 d e d, v o l 4 , P t 2 . N e w Y o rk :

G ru ne & S tra tto n , 1 97 3 : 1

6 . S h a n k s S C , K e rle y P . A tex tbook o f x -ray d iagnos is by B ritish

au tho rs ,

4 th ed , vo l 3 . P h ila d e lph ia : S a un de rs , 19 73 : 8 8

7 . E n g le S . T he ch ild s lu ng .

A nn A rbo r: U n iv e rs ity M ic ro film s , 1 95 5

8 . M ou n ie r-K u h n P . D ila ta tio n d e Ia tra ch { 23 3 }e ;o n s ta ta tio n s ra d i-

o gra ph iq ue s e t b ro nc ho sc op iq ue s.

Lyon M ed 1932 ;1 5 0 : 1 06 -

10 9

F ig .

6 .-S abe r-s he a th tra ch ea . C oron a l d ia m ete r (A ,

so lid lin e = 1 6 m m :

s ag itta l d ia m ete r (B ,

s ol id li ne =

30 m m . B ro ke n lin e m arks le ve l o f to p o f

a ort ic a rc h.)

9 . Jo h n so n T H ,

M ik ita J J , W ilson R J , F e is t JH . A cq u ired tra che o -

ma lac ia .

Rad io logy 1973 ;1 0 9

: 5 7 7- 58 0

1 0 . H o w lan d W J Jr ,

G o o d C A . T h e ra d io g rap h ic fe a tu re s o f tra ch -

e op ath ia o ste ob la stic a.

Rad io logy

1 9 5 8 ;7 1 : 8 4 7- 85 0

1 1

. G o b so n G J , D a v is P . R e sp ira to ry co m p lic a tio n s o f re la p s in g

po lychondri t is . Tho rax 1974 ;29 : 7 26 -7 31

1 2 . S ch o w en g e rd t C G , S u ye m o to A , M a in F B . G ra n u lo m a to u s a n d

fib ro us m ed ias tin itis . A re v ie w an d an a ly s is o f 1

8 0 ca ses .

J

T ho rac ic C ard iova sc S u rg 1969 ;57 : 3 65 -3 79

1 3 . B a rre tt N A . Id io p a th ic m ed ia s tin a l fib ro s is . B r J S u rg

1958 ;

46

: 2 0 7- 21 8

1 4 . M ille r R H , S h u lm a n JB , C a na lis R F , e t a l. K leb s ie lla rh in o sc le ro -

m atis : a c lin ic a l an d p a th og en ic e n ig m a.

O to la ryn g o l H ead N eck

Su rg 1 9 7 9 ;8 7

: 21 2 -2 21

1 5 . G ree ne R , L e chn e r G L . S a be r-sh ea th tra ch ea : a c lin ica l a n d

fu nc tion a l s tu dy o f m arke d co ro na l n a rro w in g o f th e in tra tho ra c ic

t rachea .

Rad io logy

1 9 7 5 ;1 1 5 : 2 65 , 26 8

1 6 . S im m ond s M . U be r A lte rssa be ls che id en tra ch ea .

V irch ow s A rch

[Pa tho lAna t ]

1 9 0 5 ;1 7 9 : 1 5-2 8