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Pediatric Pathology 1994This description of congenital tracheal lesions is presented with a focus on the information derived from the specimens collected for the Laryngeal Development... (Review)
Review
This description of congenital tracheal lesions is presented with a focus on the information derived from the specimens collected for the Laryngeal Development Laboratory at the Children's Memorial Hospital in Chicago from 1975 to 1992. During this period, 115 laryngotracheal specimens were obtained, 22 of which were found to have congenital tracheal anomalies. Six specimens were determined to have tracheomalacia, including one with primary tracheomalacia and five with secondary tracheomalacia: three were associated with tracheoesophageal fistula and two with aberrant innominate artery. Thirteen specimens had a trapped first tracheal arch; one, complete tracheal rings; and two, tracheal cartilaginous sleeve. Three specimens had tracheal agenesis, and three, tracheoesophageal fistula. Some specimens have more than one tracheal anomaly. Sixteen patients also had anomalies of other systems.
Topics: Brachiocephalic Trunk; Cartilage; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Trachea; Tracheal Stenosis; Tracheoesophageal Fistula
PubMed: 8066007
DOI: 10.3109/15513819409024281 -
Pediatric Pathology & Laboratory... 1995We describe a case of pulmonary hyperplasia associated with tracheal atresia and a complete obstruction to the egress of pulmonary secretions. In classical pulmonary... (Review)
Review
We describe a case of pulmonary hyperplasia associated with tracheal atresia and a complete obstruction to the egress of pulmonary secretions. In classical pulmonary hyperplasia associated with cartilagenous laryngeal atresia and a persistent pharyngotracheal duct, the histologic appearance of the lungs is normal but exhibits "synchronous" hypermaturity. The histologic pattern in our case is much less mature, resembles CAM type III, and exhibits "asynchronous" development. We suggest that these histologic patterns be distinguished and that pulmonary hyperplasia is probably underrecognized and not nearly as rare as previously thought.
Topics: Adult; Female; Humans; Hyperplasia; Infant, Newborn; Infant, Premature; Lung; Pregnancy; Time Factors; Trachea; Ultrasonography
PubMed: 8736599
DOI: 10.3109/15513819509026941 -
Pediatric Radiology Sep 2006Tracheal agenesis is a rare and usually lethal anomaly. In the past, opaque contrast medium was injected via the esophagus to demonstrate the anatomy.
BACKGROUND
Tracheal agenesis is a rare and usually lethal anomaly. In the past, opaque contrast medium was injected via the esophagus to demonstrate the anatomy.
OBJECTIVE
To demonstrate the utility of helical and multidetector CT in delineating the aberrant anatomy in newborns with tracheal agenesis.
MATERIALS AND METHODS
Four newborns with tracheal agenesis were identified from three institutions. Imaging studies and medical records were reviewed. Each child was imaged with chest radiography. One child was imaged on a single-detector helical CT scanner and the other three on multidetector scanners.
RESULTS
Helical and multidetector CT with 2D and 3D reconstructions clearly delineated the aberrant tracheobronchial and esophageal anatomy in each infant. Minimum intensity projection reformatted CT images were particularly helpful. One infant each had type I and type II tracheal agenesis. Two infants had type III tracheal agenesis. All four infants died.
CONCLUSION
CT is a useful tool for delineating the aberrant anatomy of newborns with tracheal agenesis and thus helps in making rational clinical decisions.
Topics: Artifacts; Humans; Imaging, Three-Dimensional; Infant, Newborn; Radiographic Image Interpretation, Computer-Assisted; Radiography, Thoracic; Respiratory System Abnormalities; Tomography, Spiral Computed; Tomography, X-Ray Computed; Trachea
PubMed: 16788813
DOI: 10.1007/s00247-006-0231-1 -
Seminars in Fetal & Neonatal Medicine Oct 2013The routine use of four-chamber screening of the fetal heart was pioneered in the early 1980s and has been shown to detect reliably mainly univentricular hearts in the... (Review)
Review
The routine use of four-chamber screening of the fetal heart was pioneered in the early 1980s and has been shown to detect reliably mainly univentricular hearts in the fetus. Many conotruncal anomalies and ductal-dependent lesions may, however, not be detected with the four-chamber view alone and additional planes are needed. The three-vessel and tracheal (3VT) view is a transverse plane in the upper mediastinum demonstrating simultaneously the course and the connection of both the aortic and ductal arches, their relationship to the trachea and the visualization of the superior vena cava. The purpose of the article is to review the two-dimensional anatomy of this plane and the contribution of colour Doppler and to present a checklist to be achieved on screening ultrasound. Typical suspicions include the detection of abnormal vessel number, abnormal vessel size, abnormal course and alignment and abnormal colour Doppler pattern. Anomalies such as pulmonary and aortic stenosis and atresia, aortic coarctation, interrupted arch, tetralogy of Fallot, common arterial trunk, transposition of the great arteries, right aortic arch, double aortic arch, aberrant right subclavian artery, left superior vena cava are some of the anomalies showing an abnormal 3VT image. Recent studies on the comprehensive evaluation of the 3VT view and adjacent planes have shown the potential of visualizing the thymus and the left brachiocephalic vein during fetal echocardiography and in detecting additional rare conditions. National and international societies are increasingly recommending the use of this plane during routine ultrasound in order to improve prenatal detection rates of critical cardiac defects.
Topics: Coronary Vessel Anomalies; Coronary Vessels; Female; Fetal Development; Fetal Heart; Heart Diseases; Humans; Male; Models, Cardiovascular; Pregnancy; Trachea; Ultrasonography, Prenatal
PubMed: 23466189
DOI: 10.1016/j.siny.2013.01.007 -
Pediatric Pulmonology Jun 2024Tracheal agenesis, or tracheal atresia, is a rare congenital anomaly. The presence of a tracheoesophageal fistula (TEF) can help with breathing for newborns with... (Review)
Review
Rare type of tracheal agenesis: Unexpected presentation and immediate consideration of emergent esophageal intubation in neonatal resuscitation program. Case reports and review of the literature.
BACKGROUND
Tracheal agenesis, or tracheal atresia, is a rare congenital anomaly. The presence of a tracheoesophageal fistula (TEF) can help with breathing for newborns with tracheal agenesis. In this article, we presented three unique cases and outcomes of neonates with tracheal agenesis along with a review of the literature.
METHODS
This study consisted of a single center case series followed by a review of literature. Case reports were generated using both written and electronic medical records from a single hospital. We summarized three unique cases and outcomes of neonates with tracheal agenesis and performed a review of the literature.
RESULTS
We identified three cases of tracheal agenesis presented with severe cyanosis without spontaneous crying upon birth. Experienced pediatricians attempted to intubate the babies but were unsuccessful. Endotracheal tubes were subsequently either accidentally or purposely placed into the esophagus, and oxygen saturation levels improved. This suggested tracheal agenesis with TEF. Two cases underwent surgical intervention after resuscitation with esophageal intubation.
CONCLUSION
Esophageal intubation may be a life-sustaining ventilation support for patients with tracheal agenesis and TEF at initial resuscitation. Clinicians should suspect tracheal agenesis when a newborn presents with severe cyanosis and voiceless crying upon birth, and esophageal intubation should be immediately attempted.
Topics: Humans; Infant, Newborn; Trachea; Male; Intubation, Intratracheal; Female; Tracheoesophageal Fistula; Esophagus; Resuscitation; Cyanosis; Constriction, Pathologic
PubMed: 38695627
DOI: 10.1002/ppul.26990 -
Respiratory Medicine Jan 2019Tracheal collapse is a weakness of the tracheal wall leading to expiratory central airway collapse of more than 50% compared to inspiration. It has previously been... (Comparative Study)
Comparative Study
BACKGROUND
Tracheal collapse is a weakness of the tracheal wall leading to expiratory central airway collapse of more than 50% compared to inspiration. It has previously been discussed whether the collapsibility of the greater airways is a stable or a dynamic condition. Indeed, other well-known lung diseases such as asthma are characterized by dynamic changes with respect to pulmonary function indices. There are several different morphologies of the trachea related to collapsibility such as the crescent type and the saber-sheath type both involving the tracheal cartilage and excess dynamic airway collapse only involving the posterior membranous part of the trachea. Is the morphology of the trachea important for the course of the disease? The effect or adverse effects of inhaled corticosteroids are thought to play a role in the increasing incidence of the excess tracheal collapse. In this pilot study, we hypothesized that the excess collapsibility of the tracheal wall is dynamic.
METHODS
We prospectively examined 20 patients with excessive tracheal collapse on previous CT scans performed primarily due to bronchiectasis. A repeat CT scan was performed in order to evaluate the collapsibility. Before the repeat scan, patients were trained in maximal inspiration, expiration and breathholding. CT was performed in full inspiration and at end-expiration. Image assessment was performed on a dedicated CT workstation using standard lung window display settings. The percentage expiratory collapse based on cross sectional areas from carina to the thoracic inlet was calculated. Pulmonary function tests were performed and analysed in accordance with the American Thoracic Society and the European Respiratory Society guidelines.
RESULTS
Repeat CT scan were performed after 24 month +/- 7.2. Six of the 20 participants (30%) were males. Mean age was 67 +/- 11.3 years. Mean FEV1 was 83% of predicted, FVC 96.6 % of predicted and FEV1/FVC-ratio 71%. In 45% of the patients tracheal expiratory collapse improved (by more than 10%) based on percentage change in cross sectional areas in expiration compared to inspiration. 35% of patients showed disease progression with increased collapse and in 20% the collapsibility remained unchanged.
CONCLUSION
We demonstrate that the collapsibility in a large fraction of the patients had actually improved at the follow up examination. We do not find any dependency of the change in collapsibility on the morphology of the trachea after end expiration, use of corticosteroid, or recurrent infections. In addition, no correlation between the changes in collapse and changes in the pulmonary function tests and the symptoms is observed.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Disease Progression; Exhalation; Female; Humans; Incidence; Inhalation; Lung; Male; Middle Aged; Prospective Studies; Respiratory Function Tests; Time Factors; Tomography, X-Ray Computed; Trachea; Tracheal Diseases
PubMed: 30665510
DOI: 10.1016/j.rmed.2018.11.018 -
Journal of Ultrasound in Medicine :... May 1999
Topics: Adult; Ascites; Female; Fetal Diseases; Fetus; Humans; Lung; Male; Pregnancy; Trachea; Ultrasonography, Prenatal
PubMed: 10327017
DOI: 10.7863/jum.1999.18.5.375 -
Respiration; International Review of... 2009
Topics: Adult; Female; Humans; Trachea; Tracheal Stenosis
PubMed: 17396028
DOI: 10.1159/000101490 -
Annals of Thoracic and Cardiovascular... Apr 2022Congenital tracheal stenosis (CTS) with a bilateral tracheal bronchus (TB) has not been reported as a subtype of CTS. A novel technique to manage CTS in patients with a...
INTRODUCTION
Congenital tracheal stenosis (CTS) with a bilateral tracheal bronchus (TB) has not been reported as a subtype of CTS. A novel technique to manage CTS in patients with a bilateral TB is described.
CASE REPORT
An infant with tetralogy of Fallot underwent repair of cardiac anomaly at age 1 month. He experienced numerous cyanosis and episodes of transient respiratory arrest. Chest computed tomography (CT) demonstrated an aberrant bilateral upper lobe bronchus arising directly from the trachea and a stenotic trachea connecting the pseudo- carina to the true carina between the common right lower and left lower bronchus. On bronchoscopy, the diameter of the lumen of the narrowed segment was estimated to be less than 2 mm. Tracheal reconstruction was undertaken when he was 2 years of age. The surgical technique using a modified slide tracheoplasty for the correction of this anomaly are described. After surgery, the patient was extubated and has had no respiratory symptoms.
DISCUSSION AND CONCLUSION
The patient had unique anatomic considerations that made reconstruction challenging. Our technique of covering a stenotic section by normal trachea is a modification of the slide tracheoplasty technique and is useful for CTS with a unilateral and a bilateral TB.
Topics: Bronchi; Constriction, Pathologic; Humans; Infant; Male; Trachea; Tracheal Stenosis; Treatment Outcome
PubMed: 31996506
DOI: 10.5761/atcs.cr.19-00198 -
Pediatric Pulmonology Nov 2006Tracheal mucosal damage has been reported in autopsy specimens of cases with proximal esophageal atresia and distal tracheoesophageal fistula (EA-TEF) (Gross...
Tracheal mucosal damage has been reported in autopsy specimens of cases with proximal esophageal atresia and distal tracheoesophageal fistula (EA-TEF) (Gross classification type C). Such changes have not been reported for isolated EA (Gross classification type A). Our hypothesis is that passage of amniotic fluid (AF) through fistula via larynx and trachea may damage tracheal mucosa. An experimental study was conducted to investigate this hypothesis in the Adriamycin-induced EA-TEF model. In the first stage of the study, we tested whether the fetuses with EA-TEF associated with pyloric atresia cannot swallow AF whereas the fetuses EA-TEF without intestinal atresia can swallow AF. Carbon solution was injected into the AF for this purpose. In the second stage of study, at the 21st day of their gestation, fetuses were extirpated and dissected under microscope. In both stages, fetuses were divided into four groups as control, fetuses without tracheoesophageal abnormalities, fetuses with EA-TEF only, fetuses with pyloric atresia associated with EA-TEF. Lungs and tracheas of the all fetuses were removed for histopathological examination. While carbon particles were present in the trachea, stomachs of the fetuses without tracheoesophageal anomalies, with EA-TEF only and control fetuses, carbon particles were absent in both trachea and stomachs of the fetuses with pyloric atresia associated with EA-TEF. Histopatological examination of the tracheal mucosa showed damage throughout the trachea in the fetuses with EA-TEF only group. Tracheal mucosa was found to be normal in other groups. Bronchial mucosa and lung tissues were found to be normal in all groups. Amniotic fluid swallowed through the TEF causes histopathological changes in the tracheal mucosa of the fetuses with EA-TEF only group. These findings may also contribute to the development of new fetal treatment modalities.
Topics: Amniotic Fluid; Animals; Antibiotics, Antineoplastic; Carbon; Disease Models, Animal; Doxorubicin; Esophageal Atresia; Female; Injections, Intraperitoneal; Leukocytes; Lung; Pregnancy; Rats; Respiratory Mucosa; Stomach; Trachea; Tracheoesophageal Fistula
PubMed: 16871620
DOI: 10.1002/ppul.20490