Investigation of Subcarinal Angle and Tracheobronchial Morphology in Patients with COVID 19: A Retrospective Computed Tomography Study
Öz
Objective: Morphological features of the trachea are very important in choosing the correct endotracheal tube size for intubation. In this study, it was proposed to reveal the effect of SARS-CoV-2 on tracheobronchial morphology and subcarinal angle.
Method: 56 (26 female, 30 male) COVID-19 and 48 (24 female, 24 male) healthy individuals aged 40 and over were included in the study. The mean age of female patients with COVID-19 was 51.30±12.78 years, while the women in the control group were 45.00±11.89 years. The mean age of male patients with COVID-19 was 48.73±13.99 years, while the mean age of men in the control group was 43.76±8.45 years. The trachea length (TL), proximal, middle and distal levels anteroposterior (AP) and transverse (TR) trachea diameters (TD), subcarinal angle (SA), proximal right main bronchus (RMB) and left main bronchus (LMB) diameters were also measured on computed tomography (CT) images.
Results: The RMB angle was higher in men with COVID-19 than in the control group (p=0.005). TL was lower in women with COVID-19 than in the control group (p=0.030). Proximal AP-TD was higher in men with COVID-19 than in the control group (p=0.006). Proximal TR-TD was lower in men with COVID-19 than in the control group (p=0.029). TL, proximal, middle, and distal levels of AP and TR-TD,SA, RMB, and LMB angles, and proximal RMB and LMB diameters were found to be lower in women with COVID-19 than in men with COVID-19 (p=0.001).
Conclusion: It was deduced that tracheobronchial morphology might change in patients infected with SARS-CoV-2.It is clinically important that this situation should not be overlooked, especially in the indication of endotracheal intubation.
Anahtar Kelimeler
COVID 19 SARS-CoV-2 Trachea Bronchi Subcarinal angle Morphology CT
Kaynakça
- 1. Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina, and bronchi. Thoracic Surgery Clinics. 2007;17(4):571-85.
- 2. Küpeli A, Ünver E: Evaluation of Tracheobronchial Changes in Chronic Obstructive Pulmonary Disease with Computed Tomography. Sakarya Tıp Dergisi. 2019;9(4):687-92.
- 3. Daroszewski M, Szpinda M, Wiśniewski M, Flisiński P, Szpinda A, WoŸniak A, et al. Tracheo-bronchial angles in the human fetus–an anatomical, digital, and statistical study. Medical Science Monitor Basic Research. 2013;19:194.
- 4. Mi W, Zhang C, Wang H, Cao J, Li C, Yang L, et al. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS One. 2015;10(4):e0123177.
- 5. Taskin V, Bates MC, Chillag SA. Tracheal carinal angle and left atrial size. Archives Of Internal Medicine. 1991;151(2):307-8.
- 6. Karabulut N. CT assessment of tracheal carinal angle and its determinants. The British Journal of Radiology. 2005;78(933):787-90.
- 7. Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. European Respiratory Journal. 2020;55(4):2000607.
- 8. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-80. e278.
- 9. To K, Lo AW. Exploring the pathogenesis of severe acute respiratory syndrome (SARS): the tissue distribution of the coronavirus (SARS‐CoV) and its putative receptor, angiotensin‐converting enzyme 2 (ACE2). The Journal of Pathology. 2004; 203(3):740-3.
- 10. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiology. 2020; 5(7):831-40.
- 11. Kumar S, Nyodu R, Maurya VK, Saxena SK: Morphology, genome organization, replication, and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Coronavirus Disease 2019 (COVID-19). Springer. 2020; 23-31.
- 12. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 2020; 395(10234):1417-8.
- 13. Cevik M, Kuppalli K, Kindrachuk J, Peiris M: Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. 2020;371
- 14. Zhang Y, Geng X, Tan Y, Li Q, Xu C, Xu J, et al. New understanding of the damage of SARS-CoV-2 infection outside the respiratory system. Biomedicine & Pharmacotherapy. 2020;127:110195.
- 15. Hill RD, Vaidya PN. Angiotensin II Receptor Blockers (ARB). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; March 28, 2022.
- 16. Kligerman S, Sharma A. Radiologic evaluation of the trachea. Semin Thorac Cardiovasc Surg. 2009;21:246-54.
- 17. Acar T, Bayraktaroğlu S, Ceylan N, Savaş R. Computed tomography findings of tracheobronchial system diseases: A pictorial essay. Jpn J Radiol. 2015;33:51-8.
- 18. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. Jama. 2020;324(8):782-93.
- 19. Anwar A, Ramos-Bascon N, Crerar-Gilbert AA, Barnes N, Madden B. A specialised cardiorespiratory team approach in the intensive care management of COVID-19 patients: benefit on mortality, diagnosis and management. Clinical Medicine. 2021;21(2):101.
- 20. Kamel KS, Lau G, Stringer MD. In vivo and in vitro morphometry of the human trachea. Clinical Anatomy. 2009;22(5):571-9.
- 21. Khade BA, Yadav N, Divan C, Khade BA. Morphometry of human trachea in male and female using computerized tomography-a comparative study. Indian Journal of Clinical Anatomy and Physiology. 2016;3(4):526-30.
- 22. Miller K, Chang A. Acute inhalation injury. Emergency Medicine Clinics. 2003;21(2):533-57.
- 23. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020; 395(10223):497-506.
- 24. Mangalmurti N, Hunter CA. Cytokine storms: understanding COVID-19. Immunity. 2020;53(1):19-25. 25. Xu Z SL, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;(4):420-2.
- 26. Hoppe H, Dinkel H-P, Walder B, von Allmen G, Gugger M, Vock P. Grading airway stenosis down to the segmental level using virtual bronchoscopy. Chest. 2004; 125(2):704-11.
- 27. Ünlü S, Ilgar M, Akçiçek M. The evaluation of the trachea as a new parameter in determining the prognosis of COVID-19: First pilot study. Eur Rer Med Pharmacol Sci. 2021;25:4835-40.
- 28. Rendina EA, Maurizi G. Commentary: Coronavirus disease 2019 (COVID-19) and the airway: How can surgery help?. JTCVS Techniques. 2020;4:365.
COVID 19’lu Hastalarda Subkarinal Açı ve Trakeobronşiyal Morfolojinin İncelenmesi: Retrospektif Bilgisayarlı Tomografi Çalışması
Öz
Amaç: Trakeanın morfolojik özellikleri, entübasyonda doğru endotrakeal tüp boyutunu seçmede oldukça önemlidir. Çalışmada SARS-CoV-2’nin trakeobronşiyal morfolojiye ve subkarinal açıya olan etkisinin ortaya konulması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya 40 yaş ve üstü 56 (26 kadın, 30 erkek) COVID-19 ve 48 (24 kadın, 24 erkek) sağlıklı birey dahil edilmiştir. COVID-19'lu kadın hastaların yaş ortalaması 51,30±12,78 yıl iken, kontrol grubundaki kadınların yaş ortalaması 45,00±11,89 yıldır. COVID-19'lu erkek hastaların yaş ortalaması 48,73±13,99 yıl iken, kontrol grubundaki erkeklerin yaş ortalaması 43,76±8,45 yıldır. Bilgisayarlı tomografi (BT) görüntüleri üzerinde trakea uzunluğu (TU), proximal, orta ve distal seviyelerde anteroposterior (AP) ve transvers (TR) trakea çapları (TÇ), subkarinal açı (SA), proximalden bronkus prinsipalis dekster (BPD) ve sinister (BPS) çapları ayrıca açıları da ölçülmüştür.
Bulgular: Çalışmaya katılan hasta ve kontrol grupları arasında her iki cinsiyette de yaş farkı istatistiksel olarak anlamlı değildi (kadınlarda p=0,051, erkeklerde p=0,126). BPD açısı COVID-19’lu erkeklerde kontrol grubuna göre daha yüksekti (p=0,005). TU COVID-19’lu kadınlarda kontrol grubuna göre daha düşüktü (p=0,030). Proksimal AP-TÇ COVID-19’lu erkeklerde kontrol grubuna göre daha yüksekti (p=0,006). Proksimal TR-TÇ COVID-19’lu erkeklerde kontrol grubuna göre daha düşüktü (p=0,029). TU, proksimal, orta ve distal seviyelerde AP ve TR-TÇ, SA, BPD ve BPS açıları, proksimalden ölçülen BPD ve BPS çapları COVID-19’lu kadınlarda COVID-19’lu erkeklerden daha düşük bulunmuştur (p=0,001).
Sonuç: SARS-CoV-2 ile enfekte olan hastalarda trakeabronşiyal morfolojinin değişebileceği sonucuna varılmıştır. Özellikle endotrakeal entübasyon endikasyonunda bu durumun gözardı edilmemesi klinik olarak önemlidir.
Anahtar Kelimeler
COVID 19 CT Bronkus Morfoloji SARS-CoV-2 Subkarinal açı Trakea.
Kaynakça
- 1. Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina, and bronchi. Thoracic Surgery Clinics. 2007;17(4):571-85.
- 2. Küpeli A, Ünver E: Evaluation of Tracheobronchial Changes in Chronic Obstructive Pulmonary Disease with Computed Tomography. Sakarya Tıp Dergisi. 2019;9(4):687-92.
- 3. Daroszewski M, Szpinda M, Wiśniewski M, Flisiński P, Szpinda A, WoŸniak A, et al. Tracheo-bronchial angles in the human fetus–an anatomical, digital, and statistical study. Medical Science Monitor Basic Research. 2013;19:194.
- 4. Mi W, Zhang C, Wang H, Cao J, Li C, Yang L, et al. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS One. 2015;10(4):e0123177.
- 5. Taskin V, Bates MC, Chillag SA. Tracheal carinal angle and left atrial size. Archives Of Internal Medicine. 1991;151(2):307-8.
- 6. Karabulut N. CT assessment of tracheal carinal angle and its determinants. The British Journal of Radiology. 2005;78(933):787-90.
- 7. Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. European Respiratory Journal. 2020;55(4):2000607.
- 8. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-80. e278.
- 9. To K, Lo AW. Exploring the pathogenesis of severe acute respiratory syndrome (SARS): the tissue distribution of the coronavirus (SARS‐CoV) and its putative receptor, angiotensin‐converting enzyme 2 (ACE2). The Journal of Pathology. 2004; 203(3):740-3.
- 10. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiology. 2020; 5(7):831-40.
- 11. Kumar S, Nyodu R, Maurya VK, Saxena SK: Morphology, genome organization, replication, and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Coronavirus Disease 2019 (COVID-19). Springer. 2020; 23-31.
- 12. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 2020; 395(10234):1417-8.
- 13. Cevik M, Kuppalli K, Kindrachuk J, Peiris M: Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. 2020;371
- 14. Zhang Y, Geng X, Tan Y, Li Q, Xu C, Xu J, et al. New understanding of the damage of SARS-CoV-2 infection outside the respiratory system. Biomedicine & Pharmacotherapy. 2020;127:110195.
- 15. Hill RD, Vaidya PN. Angiotensin II Receptor Blockers (ARB). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; March 28, 2022.
- 16. Kligerman S, Sharma A. Radiologic evaluation of the trachea. Semin Thorac Cardiovasc Surg. 2009;21:246-54.
- 17. Acar T, Bayraktaroğlu S, Ceylan N, Savaş R. Computed tomography findings of tracheobronchial system diseases: A pictorial essay. Jpn J Radiol. 2015;33:51-8.
- 18. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. Jama. 2020;324(8):782-93.
- 19. Anwar A, Ramos-Bascon N, Crerar-Gilbert AA, Barnes N, Madden B. A specialised cardiorespiratory team approach in the intensive care management of COVID-19 patients: benefit on mortality, diagnosis and management. Clinical Medicine. 2021;21(2):101.
- 20. Kamel KS, Lau G, Stringer MD. In vivo and in vitro morphometry of the human trachea. Clinical Anatomy. 2009;22(5):571-9.
- 21. Khade BA, Yadav N, Divan C, Khade BA. Morphometry of human trachea in male and female using computerized tomography-a comparative study. Indian Journal of Clinical Anatomy and Physiology. 2016;3(4):526-30.
- 22. Miller K, Chang A. Acute inhalation injury. Emergency Medicine Clinics. 2003;21(2):533-57.
- 23. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020; 395(10223):497-506.
- 24. Mangalmurti N, Hunter CA. Cytokine storms: understanding COVID-19. Immunity. 2020;53(1):19-25. 25. Xu Z SL, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;(4):420-2.
- 26. Hoppe H, Dinkel H-P, Walder B, von Allmen G, Gugger M, Vock P. Grading airway stenosis down to the segmental level using virtual bronchoscopy. Chest. 2004; 125(2):704-11.
- 27. Ünlü S, Ilgar M, Akçiçek M. The evaluation of the trachea as a new parameter in determining the prognosis of COVID-19: First pilot study. Eur Rer Med Pharmacol Sci. 2021;25:4835-40.
- 28. Rendina EA, Maurizi G. Commentary: Coronavirus disease 2019 (COVID-19) and the airway: How can surgery help?. JTCVS Techniques. 2020;4:365.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Haziran 2023 |
| Kabul Tarihi | 20 Haziran 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 15 Sayı: 2 |
