An Update on Diagnosis of Tracheomalacia in Children

Abstract

Congenital tracheomalacia is the most common congenital tracheal abnormality and occurs in approximately 1:2,100 children. Tracheomalacia can be isolated or associated with other airway anomalies such as laryngomalacia, bronchomalacia, and large laryngeal clefts. Also, an abnormal division of the embryonic foregut is frequently associated with congenital tracheomalacia; mostly in the form of proximal esophageal atresia with distal tracheoesophageal fistula. In such cases, the ratio between the cartilage ring and the posterior membranous wall drops from the normal ratio of 4 to 5:1 to 2 to 3:1. The diagnosis can be made upon clinical history and physical examination as well as by pulmonary function testing, computed tomography, dynamic magnetic resonance imaging, and fiberoptic bronchoscopy. Other approaches such as tracheobronchography have been used, but have not been validated for the diagnosis of tracheomalacia; fluoroscopy can be specific for diagnosing tracheomalacia, but lacks a reasonable sensitivity. Tracheomalacia is often self-limited and will resolve or become asymptomatic by the second year of life without intervention. For patients who remain symptomatic, possible treatments include pharmacotherapy, positive pressure application, and surgery.

Aberrant right subclavian artery syndrome manifesting as focal tracheomalacia

“…[45] The congenital variety may occur in isolation or may be found along with other defects such as laryngomalacia and laryngeal clefts. [6] Because they are unable to expel out secretions, patients with tracheomalacia present with chronic cough, dyspnea, recurrent respiratory infections, and bronchiectasis. [7]…”

Cartilage rings contribute to the proper embryonic tracheal epithelial differentiation, metabolism, and expression of inflammatory genes

“…2). On the tissue level, excess cartilage leads to tracheal narrowing and can cause airway obstruction and lung disease, while the absence of cartilage poses choking risks and breathing problems, as seen in tracheomalacia (16,25,40). On the cellular level, the presence of chondrocytes seems to negatively regulate the abundance of club cells by decreasing the population of mature cells (Fig.…”

Anaesthetic management of an infant with tracheomalacia scheduled for computed tomography angiography: A challenge

“…[3] It has an incidence of 1:2100 children. [4] Primary tracheomalacia is due to impaired maturation or deficient cartilaginous rings and/or decreased tone of the trachealis muscle and is frequently associated with comorbidities, such as craniofacial abnormalities, tracheo-oesophageal fistula, etc. [1] Secondary tracheomalacia is due to localised compression of the normal tracheal cartilage by vessel, mass, infection, or prolonged tracheostomy.…”