History
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).
Physical Examination
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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Slide tracheoplasty and left PA sling repair. Procedure performed by Giles Peek MD, FRCS, CTh, FFICM, The Children’s Hospital at Montefiore, Bronx, NY.
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This shows the trachea during inspiration and expiration. Tracheal collapse of more than 50% during expiration is diagnostic of tracheomalacia.
