Tracheomalacia: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:PMC5371593 fped-05-00060-g005.png|thumb|Bronchoscopy in a neonate showing narrowing of tracheomalacia.]] | |||
===Workup=== | ===Workup=== | ||
*[[CXR]] | *[[CXR]] | ||
===Diagnosis=== | |||
*High clinical suspicion | |||
*ENT consult for nasopharyngoscopy vs. bronchoscopy | |||
==Management== | ==Management== | ||
Revision as of 13:54, 25 September 2021
Background
- Congenital narrowing of the larygeal cartilage that causes upper airway obstruction and problems with swallowing.
- A frequent complication of surgical repair of esophageal atresia (EA) and TEF
- Most common cause of stridor in infancy
- Typically infant to <2 years
- Affects the epiglottis and/or arytenoid cartilages
- When the epiglottis is usually folds in on itself because it is abnormally elongated, and the arytenoid cartilages are abnormally large. Because the misshapen epiglottis does not function properly, it can prolapse during inspiration, causing a high pitched "stridor".
Clinical Features
- Infants
- Severe
Differential Diagnosis
Stridor
Trauma
- Larynx fracture
- Tracheobronchial tear/injury
- Thyroid gland injury/trauma
- Tracheal injury
- Electromagnetic or radiation exposure
- Burns, inhalation injury
Infectious Disorders
- Bacterial tracheitis
- Diphtheria
- Tetanus
- Tracheobronchial tuberculosis
- Poliomyelitis, paralytic, bulbar, or acute
- Fungal laryngitis
Abscesses
- Retropharyngeal abscess
- Epiglottitis, acute
- Peritonsillar abscess
- Laryngotracheobronchitis (croup)
- Retropharyngeal abscess
Neoplastic Disorders
- Neoplasms/tumors
Allergic and Auto-Immune Disorders
- Spasmodic/tracheobronchitis
- Angioedema/Angioneurotic edema
Metabolic, Storage Disorders
- Cerebral Gaucher's of infants (acute)
- Tracheobronchial amyloidosis
Biochemical Disorders
Congenital, Developmental Disorders
- Angioedema/Angioneurotic edema, hereditary
Psychiatric Disorders
- Somatization disorder
Anatomical or Mechanical
- Foreign body aspiration
- Acute gastric acid/aspiration syndrome
- Airway obstruction
- Neck compartment hemorrhage/hematoma
- Paradoxical vocal fold motion [3]
Vegetative, Autonomic, Endocrine Disorders
- Esophageal free reflux/GERD syndrome
- Laryngospasm, acute
- Bilateral vocal cord paralysis
- Hypoparathyroidism
Poisoning
Chronic Pediatric Conditions
- Laryngotracheomalacia[4]
- Subglottic stenosis or prior intubation
- Vascular ring (double aortic arch)
- Vocal cord dysfunction/paroxysmal vocal fold movement
Evaluation
Workup
Diagnosis
- High clinical suspicion
- ENT consult for nasopharyngoscopy vs. bronchoscopy
Management
- Close observation
- Recurrent “death spells”
- May require more invasive intervention such as nasal CPAP temporarily
- Aortopexy or tracheostomy for long-term relief
Disposition
- Admit
See Also
References
- ↑ *Kovesi T, Rubin S. Long-Term Complications of Congenital Esophageal Astresia and/or Tracheoesophageal Fistula. Chest. 2004;915-925.
- ↑ *Boudewyns A, Claes J, Van de Heyning P. Clinical Practic: An approach to stridor in infants and children. Eur J Pediatr. 2010;169:135-141
- ↑ Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
- ↑ Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004