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Stridor
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Both computerized tomography (CT) and magnetic resonance imaging (MRI) can demonstrate the configuration of thoracic vasculature in cases of extrinsic tracheal compression and thus are particularly useful postendoscopy. CT and MRI may also aid in the evaluation of airway lesions although they are not usually sufficiently sensitive to fully characterize a lesion or stenotic segment. Helical or multidetector CT with multiplanar and 3D reconstruction offers increasingly better definition of fixed tracheal lesions, which are effectively ‘virtual bronchoscopy’.11,12 Dynamic changes – primary and secondary tracheobronchomalacia – are not well evaluated by cross-sectional imaging. The degree, maturity and mucosal quality of a stenosis can be more accurately assessed at endoscopy.
Esophageal atresia and tracheo-esophageal fistula
Published in Prem Puri, Newborn Surgery, 2017
Indications of the severity of tracheomalacia include ventilator dependency, respiratory distress characterized by stridor and chronic carbon dioxide retention, and “dying episodes.” Full investigation for severe GER and recurrent TEF (see later) is advisable alongside evaluation of tracheomalacia, as aspiration secondary to GER and a recurrent fistula can mimic these symptoms. The extent of tracheomalacia is assessed by bronchoscopy under conditions of spontaneous respiration. The lumen of the trachea is significantly compressed anteroposteriorly and assumes a scabbard-like appearance during expiration due to tracheal cartilage deficiency. A further contribution is often made by the upper esophagus, which may bulge posteriorly into the airway. Tracheobronchomalacia can extend beyond the carina into the main stem bronchi.
Tracheomalacia: Functional Imaging of the Large Airways with Multidetector-Row CT
Published in Phillip M. Boiselle, Charles S. White, New Techniques in Cardiothoracic Imaging, 2007
The vast majority of studies reported in the literature support the use of a threshold of greater than or equal to 50% collapse as diagnostic of tracheomalacia when using either bronchoscopy or CT. However, it is important to note that several studies have advocated the adoption of different threshold values. For example, Stern et al. obtained a degree of tracheal collapse greater than 50% at end-expiration in 4 of 10 healthy young adult male volunteers scanned with an electron-beam CT (19). Based upon their findings, these authors recommended a more conservative threshold of 70% of collapse as indicative of tracheomalacia. Similarly, Heussel et al. have reported that healthy volunteers can sometimes exceed the standard diagnostic criterion (14). On the other hand, Aquino et al. studied 23 normal subjects and 10 patients with bronchoscopically-proven acquired tracheobronchomalacia using end-expiratory CT scans, and obtained a positive-predictive value of 89–100% using a threshold of >18% collapse for the upper trachea, and >28% for the midtrachea (20). Although the use of a lower threshold when imaging at end-expiration fits well with physiological principles, the low threshold values of 18% and 28% likely overlap substantially with those of normal subjects and will require further validation. In contrast, based upon a review of our preliminary experience with 64-MDCT “cine” imaging during coughing, we have suggested that a higher threshold value of 70% should be considered when using this robust provocative maneuver to elicit tracheal collapse (18).
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
We conducted a literature search on PubMed, MEDLINE, EMBASE and Cochrane Controlled Trials Register electronic databases from 1 January 1980 to 14 January 2020 (last search). Eligible studies relating to the diagnosis, investigation and management of tracheobronchomalacia in children<18 years of age were included. The keywords for the search strategy were (‘tracheomalacia’ or ‘bronchomalacia’ or ‘tracheobronchomalacia’) and (‘infant’ or ‘child’ or ‘paediatric’) and (‘symptoms’ or ‘clinical presentation’ or ‘severity’ or ‘bronchoscopy’ or ‘imaging’ or ‘treatment’ or ‘management’ or ‘physiotherapy’ or ‘airway clearance’ or ‘support’). The search was restricted to articles in the English language. The reference lists of relevant papers were hand-searched to identify any further relevant studies. Since data from all eligible studies were available, we did not need to contact the authors.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
Boesch et al. recently reported on children with persistent or recurrent wheezing. The potential anatomical cause for wheezing was identified in 45.7% of patients and inflammatory changes were identified in 49.5% of procedures. Tracheobronchomalacia was the most commonly identified anatomical lesion [42].