Role of Virtual Endoscopy and 3-D Reconstruction in Airway Assessment of Critically Ill Patients

  • Adel E. Ahmed GanawEmail author
  • Moad Ehfeda
  • Nissar Shaikh
  • Marcus Lance
  • Arshad Hussain Chanda
  • Ali O. Mohamed Belkair
  • Muhammad Zubair Labathkhan
  • Gamal Abdullah


Virtual endoscopy (VE) is a computer simulation from the imaging anatomical studies. It is noninvasive, and hence avoids all the complications of invasive conventional endoscopy. VE does not require a pre-procedural patient preparation and had a shorter procedural time. It is a very useful technique in the diagnosis and management of trachea-bronchial injuries and stenosis; placement of tracheostomy cannula in patients with abnormal anatomy; diagnosis of tracheoesophageal and laryngeal traumatic injuries, bronchopleural fistulas, and foreign body in tracheobronchial tree; and diagnosis of inhalational injury and epiglottis.


Conventional endoscopy Inhalational injury 3-Dimentional images Trachea-bronchial anatomy Injuries and fistula Virtual endoscopy 

Supplementary material

Movie 10.1

VB shows external nonmucosal compressions on the bronchial wall that cause indentation upon the related part of the trachea with subsequent reduction of its AP dimension (MP4 338 kb)

Movie 10.2

VB shows external compressions caused by normal anatomic structure (esophagus) (AVI 4888 kb)

Movie 10.3

Virtual endoscopy for a case of tracheal stenosis demonstrating the level and extent (AVI 20403 kb)

Movie 10.4

Conventional flexible endoscopic evaluation for a case of TOF (AVI 2509 kb)

Movie 10.5

(MP4 84,686 kb)


  1. 1.
    Burke AJ, et al. Evaluation of Airway Obstruction Using Virtual Endoscopy. Laryngoscope 110: January 2000. Lippincott Williams & Wilkins, Inc. Philadelphia: The American Laryngological, Rhinological and Otological Society, Inc; 2000.Google Scholar
  2. 2.
    Brink JA, Heiken JP, Wang G, et al. Helical CT: principles and technical considerations. Radiographies. 1994;14:887–93.CrossRefGoogle Scholar
  3. 3.
    Horton, et al. Advanced visualization of airways with 64-MDCT: 3-D mapping and virtual bronchoscopy. AJR. 2007;189
  4. 4.
    Tejeshwar Singh Jugpal et al Multi-detector computed tomography imaging of large airway pathology: A pictorial review. World J Radiol 2015; 7(12): 459–474.
  5. 5.
    Morshed K, et al. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol. 2011;268:591–7. Scholar
  6. 6.
    Thomas BP, et al. CT virtual endoscopy in the evaluation of large airway disease: review. AJR. 2009;192
  7. 7.
    Díaz-Jimenez P, Rodriguez AN, editors. flrxible bronchoscopy. Interventions in Pulmonary Medicine. New York: Springer; 2013. Scholar
  8. 8.
    Smyth CM, Stead RJ. Survey of flexible bronchoscopy in the United Kingdom. Eur Respir J. 2002;19:458–6.CrossRefGoogle Scholar
  9. 9.
    Stahl DL, Richard KM, Papadimos TJ. Complications of bronchoscopy: A concise synopsis. Int J Crit Illn Inj Sci. 2015;5(3):189–95. Scholar
  10. 10.
    Sodhi K. Anticipated difficult tracheostomy: should CT scan be a pre-requisite. J Emerg Intern Med. 2017;1(2):14.Google Scholar
  11. 11.
    de Kleijn BJ, et al. Virtual 3-D planning of tracheostomy placement and clinical applicability of 3-D cannula design: a three-step study. Eur Arch Otorhinolaryngol. 2018;275:451–7. Scholar
  12. 12.
    Paraschiv M. Tracheoesophageal fistula - a complication of prolonged tracheal intubation. J Med Life. 2014;7(4):516–21.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Hegde RG, et al. Esophagobronchial fi stulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause. Ind J Radiol Imag. 2013;23(2)Google Scholar
  14. 14.
    Gaur, et al. Bronchopleural fistula and the role of contemporary imaging. J Thorac Cardiovasc Surg. 2014;148:341.CrossRefGoogle Scholar
  15. 15.
    Shitrit D, Valdsislav P, Grubstein A, Bendayan D, Cohen M, Kramer MR. Accuracy of virtual bronchoscopy for grading tracheobronchial stenosis: correlation with pulmonary function test and fiberoptic bronchoscopy. Chest. 2005;128:3545–50.CrossRefGoogle Scholar
  16. 16.
    Lim KE, et al. Tracheal Injury Diagnosed with Three-Dimensional Imaging Using Multidetector Row Computed Tomography. Chang Gung Med J. 2004;27(3)Google Scholar
  17. 17.
    Prokakis, et al. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg. 2014;9:117.CrossRefGoogle Scholar
  18. 18.
    Chen JD, Shanmuganathan K, Mirvis SE, Killeen KL, Dutton RP. Using CT to diagnose tracheal rupture. AJR Am J Roentgenol. 2001;176:1273–80.CrossRefGoogle Scholar
  19. 19.
    Becker M, et al. Imaging of laryngeal trauma. Eur J Radiol. 2014;83:142–54.CrossRefGoogle Scholar
  20. 20.
    Applegate KE, Dardinger JT, Lieber ML, et al. Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies. Pediatr Radiol. 2001;31:836–40.CrossRefGoogle Scholar
  21. 21.
    Scaglione M, Romano S, Pinto A, Sparano A, Scialpi M, Rotondo A. Acutetracheobronchial injuries: impact of imaging on diagnosis and managementimplications. Eur J Radiol. 2006;59(3):336–43.CrossRefGoogle Scholar
  22. 22.
    Kosucu, et al. Low-Dose MDCT and Virtual Bronchoscopy in Pediatric Patients with Foreign Body Aspiration. AJR. 2004;183:1771–7.CrossRefGoogle Scholar
  23. 23.
    Tan HKK, Brown K, McGill T, Kenna MA, Lund DP, Healy GB. Airway foreign bodies (FB): a 10- year review. Int J Pediatr Otorhinolaryngol. 2000;56:91–9.CrossRefGoogle Scholar
  24. 24.
    Abd-ElGawad EA, et al. Tracheobronchial foreign body aspiration in infants & children: Diagnostic utility of multidetector CT with emphasis on virtual bronchoscopy. Egypt J Radiol Nucl Med. 2014;45:1141–6.CrossRefGoogle Scholar
  25. 25.
    Soo-long H, Woo GH, Jong-Lyel R. Utility of spiral and cine CT scans in pediatric patients suspected of aspirating radiolucent foreign bodies. J Otolaryngol Head Neck Surg. 2008;138:5576–80.Google Scholar
  26. 26.
    Shin S-M, Kim WS, Cheon J-E, Jung AY, Youn BJ, Kim I-O, Yeon KM. CT in children with suspected residual foreign body in airway after bronchoscopy. AJR. 2009;192:1744–51.CrossRefGoogle Scholar
  27. 27.
    Gore MA, Joshi AR, Nagarajan G, Iyer SP, Kulkarni T, Khandelwal A. Virtual bronchoscopy for diagnosis of inhalation injury in burnt patients. Burns. 2004;30:165–8.CrossRefGoogle Scholar
  28. 28.
    Tsitouridis I, et al. Endotracheal and tracheostomy tube-related complications: imaging with three-dimensional spiral computed tomography. Hippokratia. 2009;13(2):97–100.PubMedPubMedCentralGoogle Scholar
  29. 29.
    George A, et al. Virtual endoscopy for evaluation of tracheal laceration. Emerg Radiol. 2002;9:162–4. Scholar
  30. 30.
    Kwon HP, et al. Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity. Burns. 2014;40:1308–15.CrossRefGoogle Scholar
  31. 31.
    Finkelstein SE, Summers RM, Nguyen DM, Stewart JH, Tretler JA, Schrump DS. Virtual bronchoscopy for evaluation of malignant tumors of the thorax. J Thorac Cardiovasc Surg. 2002;123:967–72.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Adel E. Ahmed Ganaw
    • 1
    Email author
  • Moad Ehfeda
    • 1
  • Nissar Shaikh
    • 1
  • Marcus Lance
    • 1
  • Arshad Hussain Chanda
    • 1
  • Ali O. Mohamed Belkair
    • 1
  • Muhammad Zubair Labathkhan
    • 1
  • Gamal Abdullah
    • 1
  1. 1.Department of AnesthesiologyICU and Perioperative Medicine, Hamad Medical CorporationDohaQatar

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