• Features of the clinical picture and modern diagnostics of tracheomalacia in children

Features of the clinical picture and modern diagnostics of tracheomalacia in children

SOVREMENNAYA PEDIATRIYA.2018.2(90):59-65; doi 10.15574/SP.2018.90.59

Rudenko E. O.
Bogomolets National Medical University, Kyiv, Ukraine
National Children's Specialized Hospital «OKHMATDYT», Kyiv, Ukraine

Objective: to optimize the diagnosis of tracheomalacia in children on the basis of study of clinical presentation and data of instrumental investigations.
Material and methods. Thirty patients aged from 10 days to 17 years (21.5±7.3 months) with primary idiopathic tracheomalacia (30%, 9/30) and tracheomalacia associated with oesophageal atresia (70%, 21/30) were included to the study. Diagnostics was based on clinical symptoms, anamnesis and the data of tracheoscopy or videofibrotracheoscopy and chest computed tomography.
Results. Main symptoms of tracheomalacia were as followed: stridor (63.3%), coughing (53.3%), dyspnoea (53.3%), recurrent bronchitis and pneumonia (53.3%), inability to extubate the trachea (50%), apnoeic episodes (50%). Tracheoscopy and CT allowed assessing the degree and mechanism of functional tracheal stenosis: 1) prolapse of anterior tracheal wall, lack of tracheal cartilage; 2) widening and prolapse of tracheal membrane; 3) combination of both mechanisms. In the patients with idiopathic tracheomalacia, the first mechanism was found in 1 patient (11.1%), the second mechanism — in 5 (55.5%), and the combination of both mechanisms in 3 (33.3%) patients. In the patients with tracheomalacia, associated with oesophageal atresia, the first mechanism had 4 (19.1%), the second one — 7 (33.3%), and the combination of both variants had 10 (47.6%) patients. Most of the patients had tracheal narrowing greater than 60%, i.e. grade III–IV of stenosis (76.7%, 23/30). The patients with grade III of functional stenosis predominated (20/30, 66.7%).
Conclusions. Tracheomalacia is a rare and life-threatening abnormality and manifested by the symptoms of respiratory obstruction of variable severity. Respiratory disorders are associated with functional stenosis of the trachea due to its instability and pathological mobility. The combination of modern endoscopic and radiological research methods, in particular, dynamic videofibrotraheoscopy and computed tomography with contrast enhancement, is the most informative way to diagnose tracheomalacia in children.
Key words: airways, functional stenosis, tracheomalacia, diagnostics, children.


1. Ahel V, Banac S, Rozmanic V et al. (2003). Aortopexy and bronchopexy for the management of severe tracheomalacia and bronchomalacia. Pediatr Int. 45; 1: 104—106. https://doi.org/10.1046/j.1442-200X.2003.01660.x; PMid:12654081

2. Boiselle PM, Dippolito G, Copeland J et al. (2003). Multiplanar and 3D imaging of the central airways: comparison of image quality and radiation dose of single-detector row CT and multidetector row CT at differing tube currents in dogs. Radiology. 228; 1: 107—111. https://doi.org/10.1148/radiol.2281020730; PMid:12832576

3. Boogard R, Huijsmans SH, Pijnenburg MW. et al. (2005). Tracheomalacia and Bronchomalacia in children: incidence and patient characteristics. Chest. 128; 5: 3391—3397. https://doi.org/10.1378/chest.128.5.3391; PMid:16304290

4. Carden KA, Boiselle PM, Waltz DA et al. (2005). Tracheomalacia and tracheobronchomalacia in children and adults3an indepth review. Chest. 127; 3: 984—1005. https://doi.org/10.1378/chest.127.3.984; PMid:15764786

5. Fraga JC, Jennings RW, Kim PC. (2016). Pediatric Tracheomalacia. Seminars in Pediatric Surgery. 25; 3: 156—164. https://doi.org/10.1053/j.sempedsurg.2016.02.008; PMid:27301602

6. Hysinger EB, Panitch HB. (2016). Paediatric Tracheomalacia. Paediatric respiratory reviews. 17; 1: 9—15. https://doi.org/10.1016/j.prrv.2015.03.002; PMid:25962857

7. Javia L, Harris MA, Fuller S. (2016). Rings, slings, and other tracheal disorders in the neonate. Seminars in Fetal and Neonatal Medicine. 21; 4: 277—284. https://doi.org/10.1016/j.siny.2016.03.005; PMid:27090408

8. Jennings RW, Hamilton TE, Smithers CJ et al. (2014). Surgical appro-aches to aortopexy for severe tracheomalacia. Journal of pediatric surgery. 49; 1: 66—71. https://doi.org/10.1016/j.jpedsurg.2013.09.036; PMid:24439583

9. Kussman BD, Geva T, McGowan FX. (2004). Cardiovascular causes of airway compression. Pediatric Anesthesia. 14; 1: 60—74. https://doi.org/10.1046/j.1460-9592.2003.01192.x; PMid:14717876

10. Laberge JM, Puligandla P. (2008). Congenital malformations of the lungs and airways. In LM Taussig, LI Landau (Eds.). Pediatric Respiratory Medicine (pр. 907—942). Philadelphia: Mosby.

11. Lee EY, Strauss KJ, Tracy DA et al. (2010). Comparison of standard-dose and reduced-dose expiratory MDCT techniques for assessment of tracheomalacia in children. Academic radiology. 17; 4: 504—510. https://doi.org/10.1016/j.acra.2009.11.014; PMid:20207318

12. Leonardi B, Secinaro A, Cutrera R et al. (2015). Imaging modalities in children with vascular ring and pulmonary artery sling. Pediatric pulmonology. 50; 8: 781—788. https://doi.org/10.1002/ppul.23075; PMid:24979312

13. McNamara VM, Crabbe DCG. (2004). Tracheomalacia. Paediatr Respir Rev. 5; 2: 147—154. https://doi.org/10.1016/j.prrv.2004.01.010; PMid:15135125

14. Mok Q, Negus S, McLaren CA et al. (2005). Computed tomography versus bronchography in the diagnosis and management of tracheobronchomalacia in ventilator dependent infants. Arch Dis Child Fetal Neonatal Ed. 90; 4: 290—293. https://doi.org/10.1136/adc.2004.062604; PMid:15857878 PMCid:PMC1721907

15. Ngerncham M, Lee EY, Zurakowski D et al. (2015). Tracheobronchomalacia in pediatric patients with esophageal atresia: comparison of diagnosis laryngoscope /bronchoscopy and dynamic airway multidetector computed tomography. J Pediatr Surg. 50; 3: 402—407. https://doi.org/10.1016/j.jpedsurg.2014.08.021; PMid:25746697

16. Pan W, Peng D, Luo J et al. (2014). Clinical features of airway malacia in children: a retrospective analysis of 459 patients. Int J Clin Exper Med. 7; 9: 3005—3012. PMid:25356175 PMCid:PMC4211825

17. Sanchez MO, Greer MC, Masters IB et al. (2012). A comparison fluoros-copy airway screening with flexible bronchoscopy for diagnosing tracheomalacia. Pediatr Pulmonol. 47; 1: 63—67. https://doi.org/10.1002/ppul.21517; PMid:21830315

18. Snijders D, Barbato A. (2015). An update on diagnosis of tracheomalacia in children. European Journal of Pediatric Surgery. 25; 4: 333—335. https://doi.org/10.1055/s-0035-1559816; PMid:26276910

19. Su SC, Masters IB, Buntain H et al. (2017). A comparison of virtual bronchoscopy versus flexible bronchoscopy in the diagnosis of tracheobronchomalacia in children. Pediatric pulmonology. 52; 4: 480—486. https://doi.org/10.1002/ppul.23606; PMid:27641078

20. Walner DL, Donnelly LF, Ouanounou S et al. (1999). Utility of radiographs in the evaluation of pediatric upper airway obstruction. Annals of Otology, Rhinology & Laryngology. 108; 4: 378-383. https://doi.org/10.1177/000348949910800411; PMid:10214786