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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
Bronchomalacia, like tracheomalacia, is the dynamic collapse of the bronchi during exhalation.19–21As the bronchi have cartilage rings just as the trachea does, abnormalities in the bronchial cartilage can lead to collapse of the posterior bronchial wall into the lumen and can be seen on bronchoscopy, as shown in Video 5.4. As with tracheomalacia, this can depend on the level of anesthesia, the use of positive pressure during the procedure, and how heavily the patient is breathing.Bronchomalacia can be localized to one part of the bronchial tree or present diffusely throughout the bronchi. The mainstem bronchi are the most likely to be affected by malacia, though any bronchus can be involved.
Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Partial or complete collapse of the trachea or bronchi during respiration is caused by a lack of rigidity in the developing cartilage. To some degree, this is physiological, but it can be severe and even life-threatening. It is ‘primary’ if it occurs due to segmental or complete maldevelopment of the tracheal rings, and ‘secondary’ if it occurs as a result of compression, (e.g. by a vascular ring or in association with a TOF) where it can complicate surgical repair. In severe cases, the child will have what parents and physicians often refer to as ‘dying spells’ when the airway compromise gives rise to apnoea and cyanosis, especially brought about by expiration as the smaller airways close off. Diagnosis is confirmed by endoscopy, often supplemented by contrast bronchography, especially if there is a prominent element of bronchomalacia.
Tracheal and Bronchial Developmental Abnormalities, and Inflammatory Diseases including Bronchiectasis, Cystic Fibrosis and Bronchiolitis.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
This disorder which produces a marked dilatation of the trachea and larger bronchi has often been considered to be rare, but is becoming increasingly recognised in association with lower (and often recurrent) respiratory tract infections and bronchiectasis. Some patients have no symptoms, whilst others have repeated respiratory infections, often with a loud rasping and ineffective cough. They may go down-hill rapidly when cor pulmonale supervenes. Most cases occur in middle aged men, but the presentation can be at all ages. Some cases appear to be familial. The cause appears to be a congenital defect or atrophy of the elastic and smooth muscle of the trachea and larger bronchi. CT is very useful for showing the tracheo-bronchial abnormalites. The walls are often thinned as well as dilated, and tend to pout between atrophied and stretched tracheal rings giving rise to an irregularly corrugated appearance, and/or small posteriorly situated diverticula. In addition many cases show bronchiectasis, which is often saccular in type. The condition may progress onto tracheo-bronchomalacia.
Infantile intrathoracic large airway obstruction in a setting with a high prevalence of tuberculosis/HIV
Published in Paediatrics and International Child Health, 2018
Benjamin Wybrand Barnard, Anne-Marie Du Plessis, Pierre Goussard, Richard Denys Pitcher
The role of the innominate artery in airway compression remains controversial with a number of current, conflicting views. Researchers have questioned its clinical significance, a previous study having demonstrated an anterior innominate artery impression on the trachea in 30% of asymptomatic children <2 years of age [48]. There is also the belief that the innominate artery impression is merely secondary to underlying tracheomalacia, and that management should be focused on the primary tracheal abnormality [26,46,49,50]. However, a number of studies have implicated the innominate artery in clinically significant airway attenuation requiring surgical correction [48,50–52]. Furthermore, there is the belief that early surgical intervention is required to reduce morbidity from secondary tracheo-bronchomalacia [35,46]. The authors’ institutional policy is broadly aligned with the latter approach, with all cases of moderate or severe compression being carefully evaluated for potential surgical intervention.
Spectrum of upper airway pathology in children with Down syndrome in a single tertiary centre
Published in Acta Oto-Laryngologica, 2022
Mohammad Nasyatmuddin Yahya, Bee-See Goh, Fahrin Zara Mohammad Nasseri, Nor Azlin Kamal Nor, Wan Nurulhuda Wan Md Zin, Hasniah Abdul Latif
We found six cases had multiple concurrent UAP and all of them required further investigation under GA. Three cases diagnosed as laryngomalacia with tracheal bronchus, one case of laryngomalacia with tracheal stenosis and one case of tracheomalacia with tracheal bronchus. Another one was diagnosed as tracheomalacia with concurrent tracheal bronchus, tracheal stenosis and bronchomalacia. From all these six cases; five were congenital and one was an acquired cause.
The role of the pediatrician in caring for children with tracheobronchomalacia
Published in Expert Review of Respiratory Medicine, 2020
Manisha Ramphul, Andrew Bush, Anne Chang, Kostas N Prifits, Colin Wallis, Jayesh Mahendra Bhatt
TM can either be localized to one section of the trachea or the entire trachea [8]. If the mainstem bronchi are also affected, the term tracheobronchomalacia (TBM) is used. Bronchomalacia (BM) is the isolated weakness of one or both of the mainstem bronchi without tracheal involvement and it is rarer than TM and TBM [9].