Elsevier

The Journal of Emergency Medicine

Volume 13, Issue 1, January–February 1995, Pages 43-49
The Journal of Emergency Medicine

Clinical communication
Reversible acquired tracheobronchomalacia of a combined crescent type and saber-sheath type

https://doi.org/10.1016/0736-4679(94)00111-1Get rights and content

Abstract

A case of tracheobronchomalacia (TBM) in a 71-year-old woman, who had suffered a cough syncope, is reported. It was a combination of both the crescent type (the posterior membranous portion of trachea or bronchus protrudes into the lumen) and the saber-sheath type (the lateral cartilaginous wall of trachea or bronchus protrudes into the lumen). In this patient, acute bronchitis had developed superimposed upon a chronic bronchitis in addition to age-related regressive changes of the trachea and bronchus. A TBM due to acute inflammation can be reversible, but aggressive airway management as well as medical treatment of the underlying inflammation are critical to a successful outcome.

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Cited by (14)

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    If patients fail to respond to the usual and customary treatment of a suspected respiratory condition, consideration should be given to evaluation for TBM and HDAC. Signs and symptoms may include wheezing/stridor, barking cough, episodic choking, syncope associated with forced exhalation/cough, and recurrent pulmonary infections (bronchitis and pneumonias caused by impaired mucociliary clearance).13–15 Aside from exercise, other maneuvers that may elicit signs and symptoms are Valsalva maneuvers, positional changes (particularly recumbency), and forced exhalation/cough.

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    Classification by macroscopic clinical findings is sometimes employed, with lateral wall narrowing being called the “saber-sheath type” or “fissure shape,” and the anterioposterior wall narrowing being referred to as the “crescent type” or “scabbard shape.”17–163 Some clinicians have included a third macroscopic designation for the “circumferential” narrowing19 or have labeled this appearance as a combination of the crescent and saber-sheath types.164 Feist et al4 and others163 classified TM into congenital forms (as in the Mounier-Kuhn disease) and acquired forms, such as those resulting from tracheostomy, chest trauma, chronic irritation, inflammation, mechanical anatomic factors, or malignancy.

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