PMC4821450_01
Airway obstruction detected on patient's flow-volume loop.
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fig1
A review of her PFTs revealed fixed obstruction (Fig. 1).
Radiographic images demonstrating DAA. The right (R) and left (L) arch are seen (A), along with the trachea and esophagus (B, arrows). Esophagram (C) demonstrates obstruction and reconstructed images (D, circle) highlight the DAA. Her aortic calcification is also readily evident.
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Her chest CT (Fig. 2A and B) showed a DAA and a dilated esophagus without evidence of pulmonary fibrosis.
The anterior trachea, as seen during bronchoscopy, is flattened. Significant expiratory collapse is seen of the posterior membranous tracheal wall.
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fig3
At the level of her DAA she had a fixed anterior tracheal compression and dynamic near-complete collapse of the trachea from malacia (Fig. 3).