Imaging appearance of a post-intubation cricoid chondronecrosis

Abstract

Chondronecrosis is a known complication of external beam radiation therapy and endotracheal intubation. Radiation therapy is the most common cause of chondronecrosis owing to local cartilage ischaemia following treatment. Prolonged endotracheal intubation can lead to chondronecrosis as it is associated with excessive pressure on the cartilage by the endotracheal tube or its cuff. The cricoid ring is the most commonly affected cartilage. CT imaging is an integral part of the workup, although reports on imaging appearances are scant. We report the imaging and clinical presentation of a case of chondronecrosis secondary to the use of endotracheal tube ventilation. The patient was managed conservatively with good clinical outcome.

Figure 1.

Axial non-contrast-enhanced CT image at the level of the cricoid cartilage (a) shows a discontinuous posterior ring with an isolated sclerotic component (arrow). There is diffuse soft tissue swelling, encroaching on the air column (triangle). (b) An additional axial image shows bone fragments (arrow). (c) Sagittal reconstruction demonstrates a hypodense postcricoid soft tissue swelling (triangle) with multiple bone fragments (arrow).

Figure 2.

Coronal minimal intensity projection (a) shows a diffuse soft tissue swelling (black arrow) centred around the posterior arch of the cricoid cartilage with reduction in the airway calibre. (b) Axial CT image showing the cricoid bone fragment with the soft tissue swelling (open arrow). (c) Endoscopic view of the subglottic region from volumetric CT data, viewed caudocranially towards the subglottic region (inset) shows diffuse soft tissue swelling along the posterior wall of the subglottic trachea (arrow).