Determining normal values for lower trachea and bronchi size in children by computed tomography (CT)

Pediatr Pulmonol. 2021 Sep;56(9):2940-2948. doi: 10.1002/ppul.25536. Epub 2021 Jun 29.


Background: Normative data for central airway dimensions are a prerequisite to objectively assess large airway pathologies. Studies with computed tomography (CT) measurements of normal trachea and bronchi size in children are scarce.

Objective: The purpose of this study is to establish normal values of central airway dimensions in children by CT.

Methods: The study included chest CT studies from children aged 0-18 years. Any condition that predisposed the patient to have an abnormal tracheal or bronchial size was excluded. Airway diameters and cross-sectional area (CSA) were measured using double oblique reconstructions at five levels: proximal trachea, mid-trachea, distal trachea, right main bronchus, and left main bronchus.

Results: The inclusion criteria were met by 110 subjects (mean age, 10.8 years; SD, 5.2 years). Various regression models that considered the relationship between patient demographics and anteroposterior (AP) diameter, transverse diameter, and CSA at each of the five levels were assessed. R2 was utilized to select the best model. Multiple formulae (using patient age) were developed to calculate expected normal dimensions for five levels in the central airways on the natural log scale. Finally, z-scores were obtained for central airway dimensions at these five levels.

Conclusion: Normative data in pediatric central airways are crucial to identify large airway pathologies. We propose using the formulae devised in our study to calculate the predicted dimensions of central airways and their z-scores in pediatric patients. Normative data from our study will aid in objective quantification of central airways, increase clinician confidence, and provide appropriate patient care.

Keywords: chest CT; multiplanar reformations; normal central airway dimensions; pediatric; z-score.

MeSH terms

  • Adolescent
  • Bronchi* / diagnostic imaging
  • Child
  • Child, Preschool
  • Humans
  • Reference Values
  • Tomography, X-Ray Computed
  • Trachea* / diagnostic imaging