Chest
Volume 127, Issue 3, March 2005, Pages 984-1005
Journal home page for Chest

Reviews
Tracheomalacia and Tracheobronchomalacia in Children and Adults: An In-depth Review

https://doi.org/10.1378/chest.127.3.984Get rights and content

Tracheomalacia and tracheobronchomalacia are disorders that are encountered in both pediatric and adult medicine. Despite increasing recognition of these disease processes, there remains some uncertainty regarding their identification, causes, and treatment. This article is intended to be a comprehensive review of both the adult and pediatric forms of the diseases, and includes sections on the historical aspects of the disorders, and their classification, associated conditions, histopathology, and natural history. We also review the various modalities that are used for diagnosis as well as the state of the art of treatment, including airway stent placement and surgical intervention

Section snippets

History

The earliest references to the disease we now call TM are from the 1930s and 1940s, when clinicians described congenital thoracic vascular abnormalities that resulted in tracheal obstruction.9, 10, 11In 1948, Gross and Neuhauser12 described an infant with cough, wheezing, cyanosis, and spontaneous hyperextension of the head. Her trachea was compressed by an anomalous innominate artery that, despite surgical correction, had structurally deformed the trachea. One year later, Evans13 described

History

In 1897, Czyhlarz156 was the first to describe the postmortem finding of an unusually large trachea and bronchi. The first clinical report of isolated tracheal enlargement in an adult was by Mounier-Kuhn157 in 1932. Lemoine158 was the first to use bronchoscopy to document acquired tracheal enlargement in the adult in 1949. Additional case reports159, 160, 161of TM in adults began to appear in the 1950s. Ferraris161 described two patients with acquired TM who both reported “expiratory dyspnea,”

Conclusion

TM and TBM are becoming more commonly recognized and treated in children and adults. The causes and, therefore, the treatments vary, so a working knowledge of the options is important. Noninvasive imaging technology is increasingly being employed for diagnosis, and novel treatments, such as definitive surgical placation and stabilization with removable stents, are becoming alternatives to conservative interventions, such as CPAP. As a result of the complexity of these conditions and the options

Acknowledgments

The authors thank Simon Ashiku, MD (Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA), Carl O'Donnell, ScD, MPH (Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center), and David Feller-Kopman (Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center) for their help in the preparation of this article.

References (243)

  • JS Vasko et al.

    Surgical management of secondary tracheomalacia

    Ann Thorac Surg

    (1968)
  • R Koopot et al.

    Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction: pulmonary artery sling

    J Thorac Cardiovasc Surg

    (1975)
  • ME Dailey et al.

    Airway compression secondary to left atrial enlargment with increased pulmonary artery pressure

    Int J Pediatr Otorhinolaryngol

    (1990)
  • TM Andrews et al.

    Abnormalities of the bony thorax causing tracheobronchial compression

    Int J Pediatr Otorhinolaryngol

    (1990)
  • S Godfrey

    Association between pectus excavatum and segmental bronchomalacia

    J Pediatr

    (1980)
  • K Kimura et al.

    Aortosternopexy for tracheomalacia following repair of esophageal atresia: evaluation by cine-CT and technical refinement

    J Pediatr Surg

    (1990)
  • RW Miller et al.

    Tracheobronchial abnormalities in infants with bronchopulmonary dysplasia

    J Pediatr

    (1987)
  • SK Greenholz et al.

    Surgical implications of bronchopulmonary dysplasia

    J Pediatr Surg

    (1987)
  • H Lindahl et al.

    Bronchoscopy during the first month of life

    J Pediatr Surg

    (1992)
  • H Bibi et al.

    The prevalence of gastroesophageal reflux in children with tracheomalacia and laryngomalacia

    Chest

    (2001)
  • L Spitz et al.

    Esophageal atresia: five year experience with 148 cases

    J Pediatr Surg

    (1987)
  • I Vinograd et al.

    Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia

    J Pediatr Surg

    (1987)
  • TR Weber et al.

    Aortic suspension (aortopexy) for severe tracheomalacia in infants and children

    Am J Surg

    (2002)
  • D Sommer et al.

    Advances in the management of major airway collapse: the use of airway stents

    Otolaryngol Clin North Am

    (2000)
  • MZ Schwartz et al.

    Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy

    J Pediatr Surg

    (1980)
  • MR Davies et al.

    The flaccid trachea and tracheoesophageal congenital anomalies

    J Pediatr Surg

    (1978)
  • J Austin et al.

    Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment, and anaesthesia management

    Paediatr Anaesth

    (2003)
  • MH Wittenborg et al.

    Crocker, D Tracheal dynamics in infants with respiratory distress, stridor, and collapsing trachea

    Radiology

    (1967)
  • P Heinbecker

    A method for the demonstration of calibre changes in the bronchi in normal respiration

    J Clin Invest

    (1927)
  • J Nuutinen

    Acquired tracheobronchomalacia

    Eur J Respir Dis

    (1982)
  • EM Kiely et al.

    Management of tracheomalacia by aortopexy

    Pediatr Surg Int

    (1987)
  • EA Mair et al.

    Pediatric tracheobronchomalacia and major airway collapse

    Ann Otol Rhinol Laryngol

    (1992)
  • RE Gross

    Surgical relief for tracheal obstruction from a vascular ring

    N Engl J Med

    (1945)
  • HB Sprague et al.

    Clinical aspects of persistent right aortic root

    N Engl J Med

    (1933)
  • RE Gross et al.

    Compression of the trachea by an anomalous innominate artery: an operation for its relief

    Am J Dis Child

    (1948)
  • WA Evans

    Congenital obstructions of the respiratory tract: Part 1. Tracheal malformation

    AJR Am J Roentgenol

    (1949)
  • JW Kirklin et al.

    Vascular rings producing respiratory obstruction in infants

    Mayo Clin Proc

    (1950)
  • PH Holinger et al.

    Congenital malformations of the trachea, bronchi, and lung

    Ann Otol Rhinol Laryngol

    (1952)
  • PH Holinger

    Clinical aspects of congenital anomalies of the larynx, trachea, bronchi, and oesophagus: the Semon lecture

    J Laryngol Otol

    (1961)
  • JD Baxter et al.

    Tracheomalacia

    Ann Otol Rhinol Laryngol

    (1963)
  • TG Gupta et al.

    Congenital bronchomalacia

    Am J Dis Child

    (1968)
  • A Masaoka et al.

    Pediatric and adult tracheobronchomalacia

    Eur J Cardiothorac Surg

    (1996)
  • LD Holinger

    Etiology of stridor in the neonate, infant, and child

    Ann Otol Rhinol Laryngol

    (1980)
  • IN Jacobs et al.

    Tracheobronchomalacia in children

    Arch Otolaryngol Head Neck Surg

    (1994)
  • IB Masters et al.

    Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children

    Pediatr Pulmonol

    (2002)
  • SC Adler et al.

    Innominate artery compression of the trachea: diagnosis and treatment by anterior suspension: a 25-year experience

    Ann Otol Rhinol Laryngol

    (1995)
  • CH Johner et al.

    Polychondritis in a newborn presenting as tracheomalacia

    Ann Otol Rhinol Laryngol

    (1970)
  • J Shapiro et al.

    Airway obstruction and sleep apnea in Hurler and Hunter syndromes

    Ann Otol Rhinol Laryngol

    (1985)
  • B Benjamin

    Tracheomalacia in infants and children

    Ann Otol Rhinol Laryngol

    (1984)
  • F Paston et al.

    Tracheomalacia

    Pediatr Rev

    (1996)
  • Cited by (0)

    View full text