Radiology Case 347: Rare Tracheobronchial Smooth Muscle Atrophy and Separation in a Smoker

CT in a 69-year-old smoker with dysphonia and severe airway obstruction (FEV1 0.6L, FEV1/FVC 0.33) revealed tracheobronchial smooth muscle atrophy and separation, a rare complication of chronic inhaled corticosteroids.

• Single case report with serial low-dose CT scans from 2019-2024 showing progressive tracheobronchial smooth muscle atrophy.
• Pulmonary function tests: severe fixed obstruction, air trapping (RV >120% predicted), reduced DLCO (51%), and no bronchodilator response.
• Limitation: single case, establishing causation with inhaled corticosteroids is challenging.

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