Relapsing Polychondritis

Relapsing Polychondritis

Aqeel A. Chowdhry, MD

Tan-Lucien H. Mohammed, MD, FCCP

Frontal radiograph shows diffuse thickening of the tracheal wall image in a patient with relapsing polychondritis. Tracheal pathology is often overlooked on chest radiography.

Axial CECT shows smooth thickening of the trachea image. The airway wall is slightly increased in attenuation, but the posterior trachea image is normal.



  • Rare autoimmune episodic disorder that destroys cartilage, especially of ear, nose, and laryngotracheobronchial tree


General Features

  • Best diagnostic clue: Increased thickness and attenuation of tracheal wall

  • Patient position/location: Trachea and main bronchi most common

  • Morphology: Diffuse thickening of tracheal wall, sparing of posterior tracheal membrane

CT Findings

  • Central airways

    • Airway wall thickening

      • Distribution: Trachea & bronchi > trachea only > bronchi only

      • Diffuse with smooth external and internal contours (90%)

      • Focal and nodular uncommon

    • Increased attenuation of airway wall (100%)

      • Ranges from subtle increase in attenuation to calcification

      • Calcification is often smudgy or putty-like

      • Involves cartilaginous portions of airway only

    • Dimensions

      • Diffuse narrowing (50%)

      • Focal (50%), usually subglottic location

    • Distribution

      • Involves cartilaginous airway wall only

      • Spares posterior tracheal membrane (no cartilage)

    • Evolution

      • Malacia earliest finding, probably secondary to edema and cartilage inflammation

      • Airway wall then becomes thickened, and cartilaginous portions start to calcify

      • Stenosis late finding with scarring

  • Lung

    • Air-trapping and bronchomalacia (50%)

      • Lobular air-trapping > segmental air-trapping > lobar air-trapping

    • Mild cylindrical bronchiectasis (25%) due either to recurrent infections or direct destruction of cartilage

    • Diffuse alveolar hemorrhage associated with glomerulonephritis

  • Cardiovascular

    • Aneurysmal dilatation of aorta, especially ascending aorta root

    • Aortic wall thickening if aortitis

    • Cardiac enlargement: Aortic or mitral valve regurgitation or from pericarditis

Radiographic Findings

Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Relapsing Polychondritis
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