- 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.
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