Tracheomalacia

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Background

  • Can present as an isolated congenital lesion
  • Associated with TEF
    • A frequent complication of surgical repair of esophageal atresia (EA) and TEF
  • Typically infant to <2 years

Clinical Presentation

  • Infants
    • Brassy, barking cough
    • Can also develop “dying/death spells” that begin after 2–3 months of age[1]
      • Characterized by cyanosis, apnea, bradycardia, and hypotonia that require resuscitation[2]
  • Severe
    • Stridor at rest
    • Biphasic stridor
    • Dyspnea with feeding
    • Expiratory wheezing with respiratory infections

Differential Diagnosis

Diagnosis

Workup

  • CXR

Management

  • Close observation
  • Recurrent “death spells”
    • May require more invasive intervention such as nasal CPAP temporarily
  • Aortopexy or tracheostomy for long-term relief

Disposition

References

  1. ↑ *Kovesi T, Rubin S. Long-Term Complications of Congenital Esophageal Astresia and/or Tracheoesophageal Fistula. Chest. 2004;915-925.
  2. ↑ *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
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