Lower airway bronchoscopic interpretation
Don Hayes, Kara D. Meister in Pediatric Bronchoscopy for Clinicians, 2023
TracheomalaciaThis is a condition of excessive dynamic collapse of the trachea during the respiratory cycle. There is no standardized classification system of the degree of tracheomalacia seen, though it is often described when the airway lumen is reduced by > 50%, with severe tracheomalacia generally associated with > 90% reduction in the lumen.19–21 The presence of tracheomalacia on bronchoscopy can be very dependent on the level of anesthesia and how forcefully the patient is breathing during the procedure.In patients with tracheomalacia, the tracheal rings do not extend for the normal ~300 degrees and are often shorter and/or flattened. This results in a broader, posterior tracheal wall, which will then protrude into the airway with expiration, leading to narrowing of the tracheal lumen, as shown in Video 5.2. This will worsen with more forceful exhalation and coughing.Tracheomalacia can be localized to a small section of the trachea or extend for nearly the entire length of the trachea. It is most commonly seen near the end of the trachea before it branches into the mainstem bronchi and is often associated with bronchomalacia.
Tracheomalacia: Functional Imaging of the Large Airways with Multidetector-Row CT
Phillip M. Boiselle, Charles S. White in New Techniques in Cardiothoracic Imaging, 2007
The trachea is a compliant structure that normally dilates slightly with inspiration and narrows during expiration as a reflection of the difference between intrathoracic and intraluminal pressures (Fig. 1) (1). Tracheomalacia refers to weakness of the airway walls and/or supporting cartilage and is characterized by an accentuation of this physiological process, resulting in excessive expiratory collapse (Fig. 2) (1–4). Although the earliest reports of this condition date to the 1930s and 1940s, tracheomalacia has only recently been recognized as a relatively common and potentially treatable cause of chronic cough, dyspnea, and recurrent infections (3).
Stridor in infants
Prem Puri in Newborn Surgery, 2017
Tracheomalacia is characterized by weakness of the tracheal cartilages, widening of the posterior wall, and reduced airway caliber. These result in tracheal collapse, which becomes more evident during increased airflow periods such as crying, feeding, or coughing. 51,53,54 Tracheomalacia can be associated with various airway defects (e.g., tracheoesophageal fistula and laryngeal clefts), cardiovascular defects, developmental delay, and GERD.51,53,54
Stents for small airways: current practice
Published in Expert Review of Respiratory Medicine, 2020
Paul Zarogoulidis, Konstantinos Sapalidis, Christoforos Kosmidis, Kosmas Tsakiridis, Haidong Huang, Chong Bai, Wolfgang Hohenforst-Schmidt, Stavros Tryfon, Anastasios Vagionas, Konstantinos Drevelegas, Eleni-Isidora Perdikouri, Lutz Freitag
Airway obstruction can be induced either by cancer or benign causes. Benign bronchus stenosis is being caused by: tuberculosis, sarcoidosis, vasculitis, and chronic inflammation due to smoking in chronic obstructive pulmonary disease patients or lung transplantation [1]. Tracheomalacia can be caused by infection, and stent placement could be used if surgery is not possible. Moreover, due to malignancies (lung cancer or metastatic cancer in the bronchus), after treatment with radiotherapy or surgical intervention such as sleeve resection can lead to atelectasis and impairment of lung function [2]. The ideal airway stent should: (a) be easy to place and remove, (b) be large enough to maintain position, (c) be flexible enough to mimic airway physiology but have sufficient radial force to resist airway compression, (d) yet not too large and as congruent as possible to avoid granulation tissue reactions, and (e) not impair mucociliary clearance. The time to insert the stent is also very important; in benign inflammatory diseases we should wait until the inflammation stops, unless it is absolutely necessary for the respiration of the patient. In any case, the main purpose of stent placement is the improvement of quality of life.
Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children
Published in Journal of Asthma, 2021
Stephanie Woodward, Michael Mundorff, Cindy Weng, David G. Gamboa, Michael D. Johnson
2: A 15-month-old previously healthy 11 kg Caucasian male with tracheomalacia presented to his primary care physician’s office after 3 days of coughing and one day of respiratory distress. After no improvement with nebulized budesonide and albuterol, he was sent to a local general ED where respiratory distress was treated with IV methylprednisolone, inhaled racemic epinephrine, and 2.5 mg of inhaled albuterol. He was given IV ceftriaxone to treat pneumonia, suggested by a large left-sided opacity on chest radiography. He was admitted to the general hospital ward at the general hospital and continued on intermittent nebulized albuterol and racemic epinephrine, receiving five doses over 48 h without improvement. On the day after admission tachycardia at 262 bpm was diagnosed as SVT by EKG. This resolved spontaneously after IV fluid bolus; no vagal maneuvers or adenosine were used. He was transferred to the ICU at PCH where he received further evaluation and treatment for what was determined to be a mediastinal lymphatic malformation, treated with flovent to reduce airway inflammation, sclerotherapy, and continued intermittent doses of levalbuterol and albuterol. He had a second episode of SVT in the hospital two weeks later unrelated to any dosing of SABA which resolved with adenosine 1.1 mg. With no ventricular pre-excitation on EKG, he was then started on oral digoxin, and had another episode of SVT three weeks later during a crying episode which resolved without intervention. He stopped taking digoxin after two years, and had no subsequent episodes of SVT. He was never diagnosed with asthma.
Relapsing polychondritis: state-of-the-art review with three case presentations
Published in Postgraduate Medicine, 2021
Bogna Grygiel-Górniak, Hamza Tariq, Jacob Mitchell, Azad Mohammed, Włodzimierz Samborski
Michet et al. [25] illustrated a 5-year survival rate of 74% and a 10-year survival rate of 55%. Recent data show that survival has increased from 74% at 5 years to 91% at 10 years. Poor prognosis risk factors include the male sex, cardiac abnormalities, concomitant myelodysplasia, or hematologic malignancy[63]. The lower respiratory tract infections and airway collapse are the leading causes of mortality. The trachea wall thickened, and cartilaginous rings became easily destroyed. As a consequence, tracheomalacia develops, which results in airway collapse[36]. Renal involvement is rare, but it does have a poor prognosis, with only a 10-year survival rate of 10%[75].
Related Knowledge Centers
- Bronchomalacia
- Bronchus
- Cartilage
- Exhalation
- Laryngomalacia
- Stridor
- Trachea
- Inhalation
- Larynx
- Tracheobronchomalacia