Lung

Tracheomalacia

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Tracheomalacia, Tracheobronchomalacia

  • Epidemiology
  1. Presents in infancy
  • Pathophysiology
  1. Weakness and softness of the trachea's cartilage and walls
  2. Abnormally soft cartilage more easily collapses, narrowing the trachea, especially with expiration
  3. May result in difficult clearance of airway secretions
  • Causes
  1. Congenital (most common)
  2. Other congenital anomalies
    1. Tracheoesophageal fistula
    2. Vascular Ring
  3. Prolonged intubation
  4. Prolonged Pediatric Gastroesophageal Reflux disease
  • Signs
  1. Barking cough
  2. Expiratory Wheeze or expiratory Stridor
  3. Provocative factors (increase Wheezing)
    1. Crying
    2. Feeding
    3. Cough
    4. Nebulized beta Agonists
  • Diagnosis
  1. Bronchoscopy while child breathes spontaneously
  • Management
  1. Consult pediatric pulmonology
  2. Supportive care (most cases)
  3. Severe Tracheomalacia
    1. Tracheostomy
    2. CPAP
  • Course
  1. Self limited
  2. Improves by age 12 to 24 months
  • References
  1. Mehta and Eliason (2024) Crit Dec Emerg Med 38(6): 27-35
  2. Benjamin (1984) Ann Otol Rhinol Laryngol 93:438-42 [PubMed]