Overview
How is tracheomalacia categorized?
What is the anatomy of the trachea relevant to tracheomalacia?
What is the pathophysiology of tracheomalacia?
How is tracheomalacia classified?
What is the prevalence of tracheomalacia?
What is the prognosis of tracheomalacia?
Presentation
Which clinical history findings are characteristic of tracheomalacia?
Which physical findings are characteristic of tracheomalacia?
DDX
Which conditions should be included in the differential diagnoses of tracheomalacia?
Workup
What is the role of chest radiography in the diagnosis of tracheomalacia?
What is the role of cinefluoroscopy in the diagnosis of tracheomalacia?
What is the role of CT scanning in the diagnosis of tracheomalacia?
What is the role of endoscopy in the diagnosis of tracheomalacia?
What is the role of pulmonary function tests in the diagnosis of tracheomalacia?
Treatment
How is tracheomalacia treated?
How is tracheomalacia treated in infants?
What is the role of CPAP in the treatment of tracheomalacia?
What is the role of surgery in the treatment of tracheomalacia?
How is tracheomalacia treated in adults?
What is the role of stents in the treatment of tracheomalacia?
What is the role of tracheostomy in the treatment of tracheomalacia?
What is the role of percutaneous tracheostomy in the treatment of tracheomalacia?
What is the role of aortopexy in the treatment of tracheomalacia?
What is included in postoperative care following surgery for tracheomalacia?
What are the possible complications of tracheomalacia treatment?
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Lateral chest radiograph shows excessive tracheal narrowing.
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This shows the trachea during inspiration and expiration. Tracheal collapse of more than 50% during expiration is diagnostic of tracheomalacia.
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The mechanism of tracheal narrowing is shown here in healthy cases and in cases of tracheomalacia. Adapted from Feist JH, et al. Chest 68:3, Sept, 1975.
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Healthy trachea is visualized endoscopically.
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A 58-year-old woman with a history of polychondritis presented with inspiratory stridor and respiratory difficulties. The chest radiograph shows narrowing of the distal trachea on bronchoscopy. More than a 50% decrease in tracheal lumen occurred during expiration (see CT images).
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The CT scan of a 58-year-old woman with a history of polychondritis who presented with inspiratory stridor and respiratory difficulties shows tracheal narrowing of the distal trachea.
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CT image showing tracheal narrowing in a 58-year-old woman with a history of polychondritis who presented with inspiratory stridor and respiratory difficulties.
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A 3-dimensional reconstruction of CT scan images confirms the presence of tracheomalacia in a 58-year-old woman with a history of polychondritis who presented with inspiratory stridor and respiratory difficulties.
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Patterns of upper airway obstruction are presented here. Patient A has fixed upper airway obstruction. Patient B has variable extrathoracic obstruction, eg, vocal cord dysfunction. Patient C has variable intrathoracic obstruction, eg tracheomalacia.
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A flow volume loop shows a pattern of variable extrathoracic obstruction. Truncation of the expiratory limb is present. As the pleural pressure exceeds the airway pressure, airway collapse occurs due to flow limitation during expiration and not during inspiration.
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A flow volume loop shows the classic pattern of fixed upper airway obstruction. Truncation of both inspiratory and expiratory limbs is present.