Normal Chest, Expiratory with Tracheal Buckling

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
Unexpanded alveoli cause decreased thoracic volume.

Pathology:
Collapsed alveoli causes the diffuse opacity in the chest during expiration. The relative fixation of the trachea at the thoracic inlet while the distal trachea moves up and down during inspiration and expiration causes tracheal buckling during expiration.

Imaging Findings:
In older infants and children, a good inspiratory chest film is one in which the 6th anterior rib ends intersect the domes of the diaphragm. Because the volume of the thorax is decreased, one sees increased pulmonary opacity, pulmonary vasculature shadows become confluent and prominent, and heart and mediastinal contents increase in size and prominence. In children less than 5 years old, lateral buckling of the trachea at or just above the thoracic inlet is often seen during expiration. This tracheal buckling occurs to the side opposite the aortic arch, usually to the right.

DDX:

• Pneumonia
• Cardiomegaly
• Mediastinal mass
• Vascular congestion
• Congestive heart failure
• Pulmonary edema.

References:
See References Chapter.

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