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Anesthesiology Oct 2018
Topics: Adolescent; Bronchoscopy; Humans; Male; Mucopolysaccharidosis IV; Trachea
PubMed: 29771708
DOI: 10.1097/ALN.0000000000002268 -
Pediatric Radiology Jun 2021Mucopolysaccharidosis type IVA (MPS IVA) is characterized by progressive skeletal dysplasia and respiratory issues with difficult airway management during anesthesia.
BACKGROUND
Mucopolysaccharidosis type IVA (MPS IVA) is characterized by progressive skeletal dysplasia and respiratory issues with difficult airway management during anesthesia.
OBJECTIVE
To characterize tracheal abnormalities in children and adults with MPS IVA including interplay of the trachea, vasculature, bones and thyroid at the thoracic inlet.
MATERIALS AND METHODS
Computed tomography (CT) angiograms of the chest were analyzed for trachea shape, narrowing and deviation at the thoracic inlet, course of vasculature, bone alignment and thyroid location. The tracheal cross-sectional area was measured at the cervical, thoracic inlet and intrathoracic levels.
RESULTS
Thirty-seven patients (mean age: 18.1 years) were included. The mean tracheal cross-sectional area narrowing at the thoracic inlet was 63.9% (range: -2.1-96%), with a trend for increased tracheal narrowing in older children. The trachea was commonly deviated rightward posterior (22/37, 59%). T- or W-shaped tracheas had two times greater tracheal narrowing than D- or U-shaped tracheas (P<0.05). The brachiocephalic artery was tortuous in 35/37 (95%) with direct impingement on the trachea in 24/37 (65%). No correlation was observed between bony thoracic inlet diameter and tracheal narrowing. The thyroid was located in the thoracic inlet in 28/37 (76%) cases, significantly associated with tracheal narrowing (P=0.016).
CONCLUSION
Narrowing, deviation and abnormal shape of the trachea at the thoracic inlet are common in children and adults with MPS IVA, with a trend toward increased narrowing with advancing age in children. A W- or T-shaped trachea is associated with focal tracheal narrowing. Crowding of the thoracic inlet, due to vascular tortuosity and thyroid position, appears to play a major role.
Topics: Adolescent; Adult; Angiography; Child; Computed Tomography Angiography; Humans; Mucopolysaccharidosis IV; Tomography, X-Ray Computed; Trachea
PubMed: 33608742
DOI: 10.1007/s00247-020-04946-0 -
Thorax May 1968Two cases of the rare condition of tracheobronchomegaly are reported. They occurred in people of completely different racial origin and residence. They showed the...
Two cases of the rare condition of tracheobronchomegaly are reported. They occurred in people of completely different racial origin and residence. They showed the characteristic features of this condition—loud, rasping, prolonged, remarkably ineffective cough, abnormally wide trachea and major bronchi, laxity of the cartilaginous rings and membranous part of these airways demonstrable on straight chest radiographs and bronchoscopy and confirmed at bronchography. Evidence is submitted of congenital aetiology.
Topics: Adult; Anthropometry; Bronchi; Bronchography; Bronchoscopy; Humans; Male; Trachea
PubMed: 5656767
DOI: 10.1136/thx.23.3.320 -
Revue Medicale de Liege Mar 2021Tracheomalacia (TM) is characterized by tracheal collapse due to an intrinsic anomaly resulting in a lack of rigidity of the cartilaginous rings and/or the posterior...
Tracheomalacia (TM) is characterized by tracheal collapse due to an intrinsic anomaly resulting in a lack of rigidity of the cartilaginous rings and/or the posterior membrane during expiration, coughing or crying. It may also be secondary to external compression or acquired during endobronchial diseases. TM is commonly associated with other syndromes or airway abnormalities. Tracheomalacia can be localized or diffused and if the main bronchi are involved, the term of tracheobronchomalacia (TBM) is used. The most common symptoms include expiratory stridor, barking cough and recurrent respiratory tract infections. If tracheal weakness is severe, Acute Life Threating Events (ALTE) or Brief Resolved Unexplained Event (BRUE) can occur. While mild forms usually do not require any treatment, severe TBM may require medical and/or surgical management. Amongst several possible treatments, including tracheostomy, noninvasive ventilation and airway stenting, the pexy surgical approach (posterior, anterior tracheopexy or aortopexy) is currently the favoured option.
Topics: Bronchi; Child; Cough; Humans; Trachea; Tracheobronchomalacia; Tracheomalacia
PubMed: 33682381
DOI: No ID Found -
Laryngo- Rhino- Otologie May 2024The laryngotracheal junction is an anatomical region with special pathophysiological features. This review presents clinical pictures and malformations that manifest... (Review)
Review
The laryngotracheal junction is an anatomical region with special pathophysiological features. This review presents clinical pictures and malformations that manifest pre-dilectively at this localisation in children and adolescents as well as in adults. The diagnostic procedure is discussed. The possibilities of surgical reconstruction are presented depending on the pathology and age of the patient.
Topics: Humans; Trachea; Larynx; Adolescent; Child; Plastic Surgery Procedures; Adult; Laryngostenosis
PubMed: 38697146
DOI: 10.1055/a-2181-9576 -
Methods in Molecular Biology (Clifton,... 2022Changes in blood vessels and lymphatics in health and disease are easier to understand and interpret when studied microscopically in three dimensions. The mouse trachea...
Changes in blood vessels and lymphatics in health and disease are easier to understand and interpret when studied microscopically in three dimensions. The mouse trachea is a simple, yet powerful, and versatile model system in which to achieve this. We describe practical immunohistochemical methods for fluorescence and confocal microscopy of wholemounts of the mouse trachea to achieve this purpose in which the entire vasculature can be visualized from the organ level to the cellular and subcellular level. Blood vessels and lymphatics have highly stereotyped vascular architectures that repeat in arcades between the tracheal cartilages. Arterioles, capillaries, and venules can be easily identified for the blood vessels, while the lymphatics consist of initial lymphatics and collecting lymphatics. Even small abnormalities in either blood vessels or lymphatics can be noticed and evaluated in three dimensions. We and others have used the mouse trachea for examining in situ angiogenesis and lymphangiogenesis, vascular development and regression, vessel patency, differences in transgenic mice, and pathological changes, such as increased vascular permeability induced by inflammatory mediators.
Topics: Animals; Blood Vessels; Lymphangiogenesis; Lymphatic System; Lymphatic Vessels; Mice; Mice, Transgenic; Trachea
PubMed: 35099733
DOI: 10.1007/978-1-0716-2059-5_10 -
Archives of Disease in Childhood. Fetal... Sep 1999
Topics: Animals; Fetal Diseases; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Ligation; Lung; Trachea
PubMed: 10448173
DOI: 10.1136/fn.81.2.f81 -
Journal of Applied Physiology... Oct 2022Tracheomalacia is an airway condition in which the trachea excessively collapses during breathing. Neonates diagnosed with tracheomalacia require more energy to breathe,...
Tracheomalacia is an airway condition in which the trachea excessively collapses during breathing. Neonates diagnosed with tracheomalacia require more energy to breathe, and the effect of tracheomalacia can be quantified by assessing flow-resistive work of breathing (WOB) in the trachea using computational fluid dynamics (CFD) modeling of the airway. However, CFD simulations are computationally expensive; the ability to instead predict WOB based on more straightforward measures would provide a clinically useful estimate of tracheal disease severity. The objective of this study is to quantify the WOB in the trachea using CFD and identify simple airway and/or clinical parameters that directly relate to WOB. This study included 30 neonatal intensive care unit subjects (15 with tracheomalacia and 15 without tracheomalacia). All subjects were imaged using ultrashort echo time (UTE) MRI. CFD simulations were performed using patient-specific data obtained from MRI (airway anatomy, dynamic motion, and airflow rates) to calculate the WOB in the trachea. Several airway and clinical measurements were obtained and compared with the tracheal resistive WOB. The maximum percent change in the tracheal cross-sectional area (ρ = 0.560, = 0.001), average glottis cross-sectional area (ρ = -0.488, = 0.006), minute ventilation (ρ = 0.613, < 0.001), and lung tidal volume (ρ = 0.599, < 0.001) had significant correlations with WOB. A multivariable regression model with three independent variables (minute ventilation, average glottis cross-sectional area, and minimum of the eccentricity index of the trachea) can be used to estimate WOB more accurately ( = 0.726). This statistical model may allow clinicians to estimate tracheal resistive WOB based on airway images and clinical data. The work of breathing due to resistance in the trachea is an important metric for quantifying the effect of tracheal abnormalities such as tracheomalacia, but currently requires complex dynamic imaging and computational fluid dynamics simulation to calculate it. This study produces a method to predict the tracheal work of breathing based on readily available imaging and clinical metrics.
Topics: Humans; Infant, Newborn; Lung; Tidal Volume; Trachea; Tracheomalacia; Work of Breathing
PubMed: 36049059
DOI: 10.1152/japplphysiol.00399.2022 -
Journal of the American Veterinary... Jun 2020A 7-year-old female blue crane () was initially evaluated after it had suddenly developed signs of respiratory distress following aspiration of a rock. Emergency...
CASE DESCRIPTION
A 7-year-old female blue crane () was initially evaluated after it had suddenly developed signs of respiratory distress following aspiration of a rock. Emergency tracheotomy had been performed, and the rock had been removed from the proximal cervical portion of the trachea. Fifty-one days later, the clinical signs had returned and the crane was reevaluated.
CLINICAL FINDINGS
On reevaluation, no obvious external abnormalities were appreciated at the previous surgical site and no discharge was observed from the glottis. Computed tomography and tracheoscopy revealed marked tracheal stenosis and architectural collapse of the trachea at the previous surgery site.
TREATMENT AND OUTCOME
Tracheal resection and anastomosis was performed to remove the stenotic tracheal segment. Histologic examination of the resected tracheal segment revealed pyogranulomas with intralesional coccobacilli, fungal hyphae consistent with spp, possible parasitic ova, and features suggestive of mild to moderate heterophilic and lymphoplasmacytic tracheitis. The crane was treated with piroxicam, ceftiofur crystalline free acid, terbinafine, and itraconazole. At a follow-up examination 12 weeks later, no abnormalities were appreciated, and the surgical site had completely healed.
CLINICAL RELEVANCE
To the authors' knowledge, this is the first reported case of successful tracheal resection and anastomosis in a bird of the order Gruiformes. The surgical approach used for the blue crane may be useful for removal of tracheal foreign bodies in this and other long-necked avian species.
Topics: Anastomosis, Surgical; Animals; Birds; Female; Trachea; Tracheal Stenosis; Tracheotomy
PubMed: 32412868
DOI: 10.2460/javma.256.11.1262 -
American Journal of Medical Genetics.... Dec 2012VACTERL association (sometimes termed "VATER association" depending on which component features are included) is typically defined by the presence of at least three of... (Review)
Review
VACTERL association (sometimes termed "VATER association" depending on which component features are included) is typically defined by the presence of at least three of the following congenital malformations, which tend to statistically co-occur in affected individuals: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Although the clinical criteria for VACTERL association may appear to be straightforward, there is wide variability in the way clinical geneticists define the disorder and the genetic testing strategy they use when confronted with an affected patient. In order to describe this variability and determine the most commonly used definitions and testing modalities, we present the results of survey responses by 121 clinical geneticists. We discuss the results of the survey responses, provide a literature review and commentary from a group of physicians who are currently involved in clinical and laboratory-based research on VACTERL association, and offer an algorithm for genetic testing in patients with this association.
Topics: Anal Canal; Anus, Imperforate; Data Collection; Esophagus; Fanconi Anemia; Genetic Testing; Genetics; Heart Defects, Congenital; Humans; Kidney; Limb Deformities, Congenital; Radius; Spine; Trachea
PubMed: 23165726
DOI: 10.1002/ajmg.a.35638