air trapping
Air trapping in chest imaging refers to retention of excess gas (“air”) in all or part of the lung, especially during expiration, either as a result of complete or partial airway obstruction or as a result of local abnormalities in pulmonary compliance. It may also sometimes be observed in normal individuals.
Terminology
Although not in common usage, the term gas trapping is more accurate .
Epidemiology
Air trapping is common, occurring in ~50% of CT thorax examinations .
Clinical presentation
Mild (<25% parenchyma) air trapping may be commonly symptomatic or clinically insignificant .
Pathology
Etiology
The presence of air trapping can arise from a number of causes (the mnemonic HSBC can be used to help remember these) but usually suggests airway disease (often small airways disease). Air trapping can occur in isolation, or in association with bronchiectasis, interstitial lung disease, or rarely tree-in-bud opacity, which can help narrow the etiology :
- in isolation
- with bronchiectasis
- non-tuberculous mycobacterial infection
- cystic fibrosis
- idiopathic bronchiectasis
- with interstitial lung disease
Other uncommon conditions include :
- pulmonary tumourlets
- neuroendocrine cell proliferation spectrum
- diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)
- scoliosis: especially when severe
- vasculitides
Radiographic features
CT
Air trapping is a descriptor used in lung CT seen as a decreased attenuation of pulmonary parenchyma, especially manifested as a less than normal increase in attenuation during expiratory acquisition. This appearance must be differentiated from the decreased attenuation of hypoperfusion secondary to locally increased pulmonary arterial resistance .
The concurrent presence of absence or bronchiectasis and interstitial lung disease may be useful to narrow the differential possibilities .
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