Stenosis

Stenosis (from Ancient Greek στενός (stenós) 'narrow') is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).^[3]

Stenosis
Other names	Stenoses
CT scan of a bronchial stenosis (arrow) that resulted from tracheobronchial injury
Pronunciation	/stəˈnoʊsɪs/[1][2]

Stricture as a term is usually used when narrowing is caused by contraction of smooth muscle (e.g. achalasia, prinzmetal angina); stenosis is usually used when narrowing is caused by lesion that reduces the space of lumen (e.g. atherosclerosis).^[4] The term coarctation is another synonym,^[5] but is commonly used only in the context of aortic coarctation.^[6][7]

Restenosis is the recurrence of stenosis after a procedure.^[8]

Examples

Examples of vascular stenotic lesions include:

• Intermittent claudication (peripheral artery stenosis)
• Angina (coronary artery stenosis)
• Carotid artery stenosis which predispose to (strokes and transient ischemic episodes)^[9]
• Renal artery stenosis

Types

Vascular Stenosis

Arterial stenosis

• Carotid artery stenosis
• Coronary artery stenosis
• Renal artery stenosis
• Peripheral artery stenosis
• Vertebral artery stenosis
• Cerebral artery stenosis
• Pulmonary artery stenosis
  • Congenital or acquired abnormal narrowing of pulmonary arteries along any portion of the pulmonary artery tree

Venous stenosis

• Jugular venous stenosis
• Central venous stenosis

Cardiac Valve Stenosis

Animated representation of aortic stenosis

In order from most to least common:

• Aortic valve stenosis
  • Normal aortic valves are estimated to be less than a millimeter thick.^[10] Subsequent fibrosis and calcification of the valve leads to narrowing of the valve and therefore decreased blood flow out of the heart.^[10]
• Mitral valve stenosis
  • thickening of the mitral valve (of the left heart), therefore causing narrowing
• Tricuspid valve stenosis
  • thickening of the tricuspid valve (of the right heart), therefore causing narrowing
• Pulmonary valve stenosis
  • thickening of the pulmonary valve, therefore causing narrowing

Animated representation of spinal stenosis

Neurologic/Spine Stenosis

• Spinal canal stenosis
  • Cervical stenosis
  • Thoracic stenosis
  • Lumbar stenosis
• Foraminal stenosis
• Aqueductal stenosis

Animated representation of pyloric stenosis

Gastrointestinal Stenosis

• Esophageal stenosis
  • A congenital or acquired fixed narrowing of the esophagus. ^[11]
    • Congenital subtypes
      • Tracheobronchial remnants
      • Fibromuscular thickening / fibromuscular stenosis
      • Membranous webbing or esophageal membrane
    • Acquired ^[12]
      • Injury (example: swallowing button battery ^[13])
      • Gastroesophageal reflux disease (GERD)
      • Eosinophilic esophagitis (EoE)
      • Achalasia
• Pyloric stenosis (infantile hypertrophic pyloric stenosis)
  • Relatively uncommon disorder of infants, usually between the ages of 2-12 weeks, caused by abnormal thickening of the pylorus muscle in the stomach at the junction between the end of the stomach and the beginning of the duodenum. ^[14][15]
• Small-bowel stenosis
• Colonic stenosis (bowel obstruction)
• Anal stricture
• Rectal stricture

Respiratory Stenosis

• Subglottic stenosis
  • Congenital or acquired narrowing of airway diameter in anatomic area below the vocal cords. ^[16]
• Laryngotracheal stenosis
• Bronchial stenosis

Genitourinary Stenosis

• Ureteral stenosis
• Urethral stenosis
• Cervical canal stenosis
• Meatal stenosis
• Vaginal stenosis
  • Abnormal shortening or tightening of the vaginal canal.^[17]

Others

• Biliary duct stenosis

Causes

• Alcohol
• Atherosclerosis
• Birth defects
• Calcification
• Diabetes
• Headbanging
• Iatrogenic
• Infection
• Inflammation
• Ischemia
• Neoplasm
• Smoking
• Ureteral
• Urethral

Diagnosis

Stenoses of the vascular type are often associated with unusual blood sounds resulting from turbulent flow over the narrowed blood vessel. This sound can be made audible by a stethoscope, but diagnosis is generally made or confirmed with some form of medical imaging (such as ultrasound).^[18]

See also

• Atresia