Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 13  |  Issue : 3  |  Page : 441-442

Scabbard trachea


Department of Medicine, AIIMS, New Delhi, India

Date of Submission04-Dec-2018
Date of Acceptance19-May-2019
Date of Web Publication26-Jul-2019

Correspondence Address:
Animesh Ray
Department of Medicine, AIIMS, New Delhi, No. 46C, Masjid Moth, Phase II, GKI, New Delhi 110029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejb.ejb_92_18

Rights and Permissions
  Abstract 

Scabbard trachea is a rare clinical observation, though commonly present in patients with chronic obstructive pulmonary disease. There is coronal narrowing of the intrathoracic part of the trachea resembling a saber sheath. We herein describe a case of scabbard trachea as a sequel of severe chronic obstructive pulmonary disease with the classical computed tomography and bronchoscopy findings.

Keywords: saber-sheath trachea, scabbard trachea, tracheal deformity


How to cite this article:
Ray A, Sindhu D. Scabbard trachea. Egypt J Bronchol 2019;13:441-2

How to cite this URL:
Ray A, Sindhu D. Scabbard trachea. Egypt J Bronchol [serial online] 2019 [cited 2019 Oct 16];13:441-2. Available from: http://www.ejbronchology.eg.net/text.asp?2019/13/3/441/263587


  Introduction Top


Scabbard trachea is an intrathoracic tracheal deformity where the corronal diameter is less than or equal to one-half of its sagittal diameter. Usually the patient is asymptomatic, unless there is greater than 50% reduction in coronal diameter. The diagnosis is made on radiographic and bronchoscopy study. We present a patient who had an acute exacerbation of chronic obstructive pulmonary disease (COPD) with lower respiratory tract infection, incidentally diagnosed to have scabbard tracheal deformity.


  Case report Top


A 70-year-old man, with a significant smoking history for 40 years, with acute exacerbations twice a year not requiring hospitalization, presented with fever for 15 days associated with dry cough. He complained of chronic cough with expectoration and seasonal exacerbation for the last few years. As the symptoms persisted after taking antibiotics, a computed tomography (CT) thorax was done which showed left lower lobe centrilobular nodules suggesting probable infection. A fiber-optic bronchoscopy was performed, which showed a peculiar appearance of the trachea ([Figure 1]). There was diffuse coronal narrowing of the intrathoracic part of the trachea with simultaneous widening of the sagittal diameter. A review of CT images also showed saber-sheath (scabbard) trachea ([Figure 2]), which is seen in patients with COPD. Bronchoalveolar lavage grew Pseudomonas aeruginosa sensitive to Piperacillin/Tazobactam, which was initiated, with prompt resolution of symptoms. A postbronchodilator spirometry confirmed severe COPD. Bronchoscopic and CT images showed characteristic appearance of scabbard or saber-sheath trachea [1],[2], which is considered to be pathognomic of COPD.
Figure 1 Fiber-optic bronchoscopic image showing scabbard trachea.

Click here to view
Figure 2 Contrast-enhanced computed tomography images showing scabbard trachea.

Click here to view



  Discussion Top


Scabbard tracheal deformity is commonly seen in patients with COPD. Greene [2] compared 60 men with marked coronal narrowing of intrathoracic trachea with 60 controls and established a strong correlation between scabbard trachea and clinical COPD.

The intrathoracic part of the trachea develops coronal narrowing and sagittal elongation, leading to resemblance to a scabbard or saber. Tracheal index [3], which refers to the ratio of the coronal and sagittal diameter of trachea at the same level, is markedly decreased in saber-sheath trachea. Tracheal index of less than two-thirds is said to have a specificity of 92.9% and sensitivity of 39.1% to diagnose severe obstructive lung disease. Elevated intrathoracic pressure coupled with repeated injury to cartilage inflicted by coughing leads to remodeling of the cartilaginous rings resulting in characteristic shape of the trachea [4]. No essential tracheal weakness is present in patients with COPD, as observed in Rayl [5] in his study on abnormal airway collapse during cough using cine-fluoroscopy. In a study conducted by Ciccarese and colleagues, it was linked to the functional severity of airway obstruction, but not to other radiological signs of COPD [6]. Thus, evaluation of the trachea at chest radiography in COPD patients is strongly recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hayes D Jr, Ballard HO. Saber-sheath trachea in a patient with bronchiolitis obliterans syndrome after lung transplantation. Chron Respir Dis 2009; 6:49–52.  Back to cited text no. 1
    
2.
Greene R. Saber-sheath trachea: relation to chronic obstructive pulmonary disease. Am J Roentgenol 1978; 130:441–445.  Back to cited text no. 2
    
3.
Tsao TC, Shieh WB. Intrathoracic tracheal dimensions and shape changes in chronic obstructive pulmonary disease. J Formos Med Assoc 1994; 93:30–34.  Back to cited text no. 3
    
4.
Ismail SA, Mehta AC. ‘Saber-sheath’ trachea. J Bronchol Intervent Pulmonol 2003; 10:296–297.  Back to cited text no. 4
    
5.
Rayl JE. Tracheobronchial collapse during cough. Radiology 1965; 85:87–92.  Back to cited text no. 5
    
6.
Ciccarese F, Poerio A, Stagni S, Attinà D, Fasano L, Carbonara P et al. Saber-sheath trachea asa marker of severe airflow obstruction in chronic obstructive pulmonary disease. Radiol Med (Torino) 2014; 119:90–96.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed161    
    Printed10    
    Emailed0    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]