Eur J Pediatr Surg 2015; 25(04): 333-335
DOI: 10.1055/s-0035-1559816
Review Article
Georg Thieme Verlag KG Stuttgart · New York

An Update on Diagnosis of Tracheomalacia in Children

Deborah Snijders
1   Department of Women's and Children's Health, University of Padova, Padova, Italy
,
Angelo Barbato
2   Pediatric Bronchoscopy Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
› Author Affiliations
Further Information

Publication History

23 June 2015

25 June 2015

Publication Date:
15 August 2015 (online)

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.

 
  • References

  • 1 Holinger PH, Johnston KC, Parchet VN, Zimmermann AA. Congenital malformations of the trachea, bronchi and lung. Ann Otol Rhinol Laryngol 1952; 61 (4) 1159-1180
  • 2 Boogaard R, Huijsmans SH, Pijnenburg MW, Tiddens HA, de Jongste JC, Merkus PJ. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest 2005; 128 (5) 3391-3397
  • 3 Masters IB, Chang AB, Patterson L , et al. Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. Pediatr Pulmonol 2002; 34 (3) 189-195
  • 4 Hysinger EB, Panitch HB. Paediatric Tracheomalacia. Paediatr Respir Rev 2015; ; e-pub ahead of print
  • 5 Leonardi B, Secinaro A, Cutrera R , et al. Imaging modalities in children with vascular ring and pulmonary artery sling. Pediatr Pulmonol 2014; ; e-pub ahead of print
  • 6 Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest 2005; 127 (3) 984-1005
  • 7 Tan JZ, Ditchfield M, Freezer N. Tracheobronchomalacia in children: review of diagnosis and definition. Pediatr Radiol 2012; 42 (8) 906-915 , quiz 1027–1028
  • 8 de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 2002; 20 (5) 1271-1276
  • 9 Hasan RA, Reddy R. Sedation with propofol for flexible bronchoscopy in children. Pediatr Pulmonol 2009; 44 (4) 373-378
  • 10 Majid A, Gaurav K, Sanchez JM , et al. Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study. Ann Am Thorac Soc 2014; 11 (6) 951-955
  • 11 Masters IB, Eastburn MM, Wootton R , et al. A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy. Thorax 2005; 60 (8) 652-658
  • 12 Williamson JP, McLaughlin RA, Phillips MJ , et al. Using optical coherence tomography to improve diagnostic and therapeutic bronchoscopy. Chest 2009; 136 (1) 272-276
  • 13 Bilan N, Miabi Z, Saiiah M. Diagnosis of airway malacia via virtual bronchoscopy. Pediatrics 2008; 121 (Suppl. 02) S158
  • 14 Oh Y, Kobayashi T, Morikawa A , et al. Utility of virtual bronchoscopy in congenital tracheomalacia. Tokai J Exp Clin Med 2007; 32 (2) 67-69
  • 15 Pan W, Peng D, Luo J , et al. Clinical features of airway malacia in children: a retrospective analysis of 459 patients. Int J Clin Exp Med 2014; 7 (9) 3005-3012
  • 16 Goyal V, Masters IB, Chang AB. Interventions for primary (intrinsic) tracheomalacia in children. Cochrane Database Syst Rev 2012; 10: CD005304
  • 17 Jennings RW, Hamilton TE, Smithers CJ, Ngerncham M, Feins N, Foker JE. Surgical approaches to aortopexy for severe tracheomalacia. J Pediatr Surg 2014; 49 (1) 66-70 , discussion 70–71
  • 18 Arnaud AP, Rex D, Elliott MJ , et al. Early experience of thoracoscopic aortopexy for severe tracheomalacia in infants after esophageal atresia and tracheo-esophageal fistula repair. J Laparoendosc Adv Surg Tech A 2014; 24 (7) 508-512