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Thoracic Surgery Clinics Feb 2014Tracheomalacia is excessive collapsibility of the trachea, typically during expiration. Congenital forms are associated with severe symptoms. Milder forms often present... (Review)
Review
Tracheomalacia is excessive collapsibility of the trachea, typically during expiration. Congenital forms are associated with severe symptoms. Milder forms often present after the neonatal period. Adult malacia is mostly associated with chronic obstructive pulmonary disease. Functional bronchoscopy is still not standardized. Dynamic airway CT is a promising tool for noninvasive diagnosis. Bronchoscopy and stent insertion lead to significant improvement, but with a high complication rate. Surgical lateropexia, tracheal resection, and surgical external stabilization are options. Tracheoplasty seems to be the best choice for selected cases of adult malacia. The most commonly performed surgery in children is aortopexy.
Topics: Adult; Bronchoscopy; Child; Humans; Pulmonary Disease, Chronic Obstructive; Tomography, X-Ray Computed; Trachea; Tracheomalacia
PubMed: 24295659
DOI: 10.1016/j.thorsurg.2013.09.003 -
QJM : Monthly Journal of the... Nov 2021
Topics: Bronchoscopy; Humans; Trachea; Tracheomalacia
PubMed: 34129045
DOI: 10.1093/qjmed/hcab170 -
Paediatric Respiratory Reviews Jan 2016Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation... (Review)
Review
Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation or periods of increased intrathoracic pressure such as crying. Extrathoracic tracheomalacia involves dynamic collapse of the airway between the glottis and sternal notch that occurs during inhalation rather than exhalation. The tone of the posterior membrane of the trachea increases throughout development and childhood, as does the rigidity of the tracheal cartilage. Abnormalities of airway maturation result in congenital tracheomalacia. Acquired tracheomalacia occurs in the normally developed trachea due to trauma, external compression, or airway inflammation. Although tracheomalacia can be suspected by history, physical examination, and supportive radiographic findings, flexible fiberoptic bronchoscopy remains the "gold standard" for diagnosis. Current treatment strategies involve pharmacotherapy with cholinergic agents, positive pressure ventilation, and surgical repair.
Topics: Bronchoscopy; Cholinergic Agents; Humans; Positive-Pressure Respiration; Tracheobronchomalacia; Tracheomalacia
PubMed: 25962857
DOI: 10.1016/j.prrv.2015.03.002 -
Paediatric Respiratory Reviews Jun 2004Tracheomalacia is a rare condition characterised by collapse of the trachea during respiration. The condition is seen most often in infants and young children. Mild... (Review)
Review
Tracheomalacia is a rare condition characterised by collapse of the trachea during respiration. The condition is seen most often in infants and young children. Mild cases can be managed expectantly; however, severe cases can be associated with life-threatening cyanotic attacks and intervention to stabilise the airway is invariably necessary. Most commonly this involves an aortopexy to suspend the anterior wall of the trachea but other options include endoluminal or extraluminal stenting, long-term positive pressure ventilation and tracheostomy. Although tracheomalacia resolves spontaneously in most infants within the first few years of life, severe tracheomalacia is associated with significant morbidity and mortality that should not be underestimated.
Topics: Cartilage Diseases; Humans; Infant; Tracheal Diseases
PubMed: 15135125
DOI: 10.1016/j.prrv.2004.01.010 -
Seminars in Pediatric Surgery Jun 2016Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane.... (Review)
Review
Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.
Topics: Aorta; Child; Combined Modality Therapy; Endoscopy; Humans; Sternotomy; Tomography, X-Ray Computed; Trachea; Tracheomalacia
PubMed: 27301602
DOI: 10.1053/j.sempedsurg.2016.02.008 -
Chest Surgery Clinics of North America May 2003Tracheomalacia is a rare tracheal problem that leads to collapse of the airway and expiratory flow obstruction. Expiratory CT scans are the diagnostic test of choice in... (Review)
Review
Tracheomalacia is a rare tracheal problem that leads to collapse of the airway and expiratory flow obstruction. Expiratory CT scans are the diagnostic test of choice in adults. Chronic obstructive pulmonary disease is the most common cause of adult tracheomalacia. Plication of the membranous wall to polypropylene mesh to recreate the normal airway shape (membranous wall tracheoplasty) is an effective treatment in adults.
Topics: Adult; Airway Obstruction; Bronchoscopy; Cartilage Diseases; Humans; Infant, Newborn; Intubation, Intratracheal; Respiratory Function Tests; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Trachea; Tracheal Diseases
PubMed: 12755319
DOI: 10.1016/s1052-3359(03)00036-x -
The European Respiratory Journal Sep 2019Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The...
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
Topics: Bronchomalacia; Bronchoscopy; Child; Europe; Humans; Magnetic Resonance Imaging; Multidetector Computed Tomography; Physical Therapy Modalities; Pulmonary Medicine; Respiratory Function Tests; Respiratory Sounds; Societies, Medical; Tracheomalacia
PubMed: 31320455
DOI: 10.1183/13993003.00382-2019 -
Current Problems in Pediatric and... Apr 2018Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital... (Review)
Review
Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital abnormalities of the pediatric airway and are characterized by increased airway compliance, resulting in excessive dynamic collapse during the respiratory cycle. While a diagnosis can be suspected based on clinical history and physical examination, definitive evaluation is based of nasopharyngolaryngoscopy and/or bronchoscopy. Observation and conservative management are typically all that are required. However, surgical intervention can be necessary in the most severe cases, and can result in significant improvement in symptoms.
Topics: Bronchomalacia; Bronchoscopy; Conservative Treatment; Humans; Laryngomalacia; Pediatrics; Severity of Illness Index; Tracheomalacia; Watchful Waiting
PubMed: 29622320
DOI: 10.1016/j.cppeds.2018.03.002 -
Pediatric Pulmonology Oct 2022Spirometry is easily accessible yet there is limited data in children with tracheomalacia. Availability of such data may inform clinical practice. We aimed to describe... (Review)
Review
OBJECTIVES
Spirometry is easily accessible yet there is limited data in children with tracheomalacia. Availability of such data may inform clinical practice. We aimed to describe spirometry indices of children with tracheomalacia, including Empey index and flow-volume curve pattern, and determine whether these indices relate with bronchoscopic features.
METHODS
From the database of children with tracheomalacia diagnosed during 2016-2019, we reviewed their flexible bronchoscopy and spirometry data in a blinded manner. We specially evaluated several spirometry indices and tracheomalacia features (cross-sectional lumen reduction, malacic length, and presence of bronchomalacia) and determined their association using multivariable regression.
RESULTS
Of 53 children with tracheomalacia, the mean (SD) peak expiratory flow (PEF) was below the normal range [68.9 percent of predicted value (23.08)]. However, all other spirometry parameters were within normal range [Z-score forced expired volume in 1 s (FEV ) = -1.18 (1.39), forced vital capacity (FVC) = -0.61 (1.46), forced expiratory flow between 25% and 75% of vital capacity (FEF ) = -1.43 (1.10), FEV /FVC = -1.04 (1.08)], Empey Index = 8.21 (1.59). The most common flow-volume curve pattern was the "knee" pattern (n = 39, 73.6%). Multivariable linear regression identified the presence of bronchomalacia was significantly associated with lower flows: FEV [coefficient (95% CI) -0.78 (-1.54, -0.02)], FEF [-0.61 (-1.22, 0)], and PEF [-12.69 (-21.13, -4.25)], all p ≤ 0.05. Other bronchoscopic-defined tracheomalacia features examined (cross-sectional lumen reduction, malacic length) were not significantly associated with spirometry indices.
CONCLUSION
The "knee" pattern in spirometry flow-volume curve is common in children with tracheomalacia but other indices, including Empey index, cannot be used to characterize tracheomalacia. Spirometry indices were not significantly associated with bronchoscopic tracheomalacia features but children with tracheobronchomalacia have significantly lower flow than those with tracheomalacia alone.
Topics: Bronchomalacia; Child; Cross-Sectional Studies; Forced Expiratory Volume; Humans; Spirometry; Tracheomalacia; Vital Capacity
PubMed: 35785487
DOI: 10.1002/ppul.26054