The central airway lesions can be divided by the way it appeared in traumatic or non-traumatic. On one hand, the traumatic tracheal injuries can be penetrating or blunt; all of them having pathognomonic radiological signs, where the important teaching point is to search where is the lesion.

On the other hand, the non-traumatic lesions can be divided for their pathology as tumoral, autoimmune, iatrogenic, among others. 

All the lesions where study with computed tomography.

Classification:

Fig. 1: Clasification of central airway lesions.
References: Department of Radiology, Clínica INDISA; Santiago, Chile

1. Non traumatic - Neoplastic

There are neoplastic airway lesions, sometimes origins directly from the trachea, other times are extrinsic compresion. Patients presents with stridor and dypnea.

Fig. 2: Case 1: Non traumatic - Neoplastic traqueal stenosis.
References: Department of Radiology, Clínica INDISA; Santiago, Chile

2. Non traumatic - Benign stenosis

Benign stenosis are a classic complication of long intubations or prolonged time in mechanical ventilatory support by tracheostomy. It can be dilated and resolved.

Fig. 3: Case 2: Non traumatic tracheal lesion – Benign stenosis. Neck Ct. A) Scout, b) sagital and c) axial reconstruction in soft tissue window. Patient has a history of prolonged intubation in the previous years
References: Department of Radiology, Clínica INDISA; Santiago, Chile

3. Non traumatic -  Autoimmune

Autoimmume diseases regarding trachea are extremely rare. You can find sarcoidosis, amyloidosis, wegener disease, lymphoma. In this case, we found an extensive parietal growth, simetrical, associated with calcifications. A pattern classic for policondritis recidivante.

Fig. 6: Case 5: Difuse traqueal stenosis, without calcifications, compatible with recidivant policondritis, a rare autoinmmune disease.
References: Department of Radiology, Clínica INDISA; Santiago, Chile

4. Traumatic - Blunt

Blunt trauma is the most common trauma of the central airway. It can produce fracture in thyroid and hyoid, as in this case, subcutaneous enphysema, tracheal lesion, and vertebral fracture. You must suspect a vascular lesion, so you must study the neck vessels.

Fig. 5: Case 4: Traumatic tracheal and thyroid lesion. Bycicle accident. Neck CT wo contrast
References: Department of Radiology, Clínica INDISA; Santiago, Chile

5. Traumatic - Iatrogenic

Iatrogenic lesions are more common that we would like. And usually are produce posterior managemente of the airway, showing a lesion in the traquea posterior a difficult intubation.

Fig. 4: Case 3: Traumatic tracheal and thyroid lesion. Bycicle accident. Neck CT wo contrast a) VRT b) Bone window c) soft tissue window.
References: Department of Radiology, Clínica INDISA; Santiago, Chile