Respiratory Tract Malacia: Possible cause of sudden death in infancy and early childhood

Abstract

Aim: To stress the importance of considering Laryngo‐tracheo‐bronchomalacia (LTBM) as a cause of death in infancy and early childhood. Methods: A case of Tracheo‐bronchomalacia diagnosed at autopsy is presented, with a short review of the literature. Results: The condition causes functional weakness of the airways due to congenital or acquired abnormalities of airway cartilage. The etiology of the congenital variant is uncertain; the acquired may be caused by localized external pressure. Morphologically, cartilage rings are shorter and softer than normal, causing collapse, especially during forced expirations. The defect can be an isolated finding, but there are a number of associations with other malformations. LTBM may be misdiagnosed as asthma. Symptoms include wheezing, barking cough, frequent respiratory infections and cyanotic episodes. Treatment might be conservative or include surgery, depending on etiology and severity. Conclusion: Laryngo‐tracheo‐bronchomalacia (LTBM) is usually not considered a sufficient cause of death in infancy and early childhood, but airway malacia may be an unrecognized cause of sudden death in infancy and early childhood, and should be considered, especially in cases where there is a history of respiratory distress.