Pediatric Tracheomalacia Clinical Presentation

Updated: Jul 30, 2018
  • Author: Emily Concepcion, DO; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Presentation

History

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  • The history of a patient with tracheomalacia typically includes a wheeze that usually begins when the individual is aged 4-8 weeks. Although the congenital lesion is present before this time, airflow is apparently insufficient during the first few weeks of life to generate abnormal sounds. The wheeze generally increases with activity and colds and decreases during quiet periods.

  • At first, wheezing may be mistaken for a sign of bronchiolitis, especially during respiratory syncytial virus season. As wheezing continues, it may be mistaken for that of asthma or cystic fibrosis. If bronchodilator therapy has been attempted, the history usually indicates no improvement; however, in some infants, tracheomalacia worsens with bronchodilator therapy.

  • Unlike most infants with asthma or cystic fibrosis, infants with tracheomalacia are described as "happy wheezers" (ie, they maintain normal oxygenation and disposition and grow and develop normally, despite the chronic airway noises).

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Physical

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  • The physical findings suggest the diagnosis.

  • The baby looks well and happy despite the chronic wheeze.

  • Vital signs, including the patient's respiratory rate and oxygen saturation, are normal.

  • Lungs have good air entry. The typical abnormality is of a wheeze throughout exhalation that sounds the same in all lung fields. It is a coarse monophonic exhalatory sound, which has been described as exhalatory stridor. No asymmetry to the breath sounds is present. On occasion, the lesion is intrathoracic, and the airway sounds occur in inspiration.

  • The patient's voice and cry are normal, unless gastroesophageal reflux is present.

  • Because some children have concomitant laryngomalacia, abnormal sounds may be heard on inspiration.

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Causes

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  • As far as tracheomalacia is understood, most cases are isolated and idiopathic. A recent study proposed a possible neurologic etiology for tracheomalacia. This group was caring for a child with increased intracranial pressure. When the pressure was elevated, the child developed tracheomalacia. When the pressure was relieved, the tracheomalacia remitted. This scenario recurred, although the etiology for increased intracranial pressure causing tracheomalacia is unknow. [3]

  • Transient defects in tracheal cartilage development are assumed to be the cause of this condition. This is sometimes referred to as type 1 tracheomalacia.

  • Autopsy data are lacking, and no animal model is noted.

  • Some children with tracheomalacia have the lesion because of vascular anomalies or other causes of compression of the airway. This is referred to as type 2 tracheomalacia.

  • Tracheomalacia is a common finding after repair of a tracheoesophageal fistula.

  • Tracheomalacia may occur with and complicate other disorders, including gastroesophageal reflux disease, other forms of recurrent aspiration, and bronchopulmonary dysplasia (chronic lung disease of infancy).

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