Tracheobronchial pathologyDr. Rahmanofa YunizafEndoscopy-Bronchoesophagology DivisionENT Department FKUI-RSCM

TRACHEOMALACIA

Tracheomalacia commonly involves most of the trachea and other major airways.

wheeze, cough, stridor, dyspnea, tachypnea, cyanosis, recurrent respiratory tract infections.

Congenital diffuse malacia of the airway improves by age 6–12 months.

The structural integrity of the trachea is restored gradually.

TRACHEOMALACIA

Type I : congenital or intrinsic tracheal abnormalities associated with a tracheoesophageal fistula or esophageal atresia.

Type II : extrinsic defects or anomalies, vascular ring causing undue pressure on the trachea.

Type III : acquired tracheomalacia , with prolonged intubation, chronic tracheal infections, or inflammatory conditions like relapsing polychondritis.

TRACHEOMALACIA

Lateral fluoroscopy ,esophagogram diagnostic.

Fluoroscopy:

Cine computed tomography (CT Scan)

Endoscopy

TRACHEOMALACIA

2 MOS OLD BABY

STRIDOR

MARKED DIFFUSE TRACHEAL NARROWING DURING EXPIRATION

THE TRACHEA PERSISTENLY

NARROWED

Berrocal T et al. Radiographics 2004;24:e17-e17

TRACHEOMALACIA

A 3 WEEK OLD BABY WITH HURLER DISEASETHE TRACHEA WAS NOTED TO BE PERSISTENTLY

NARROWED IN ALL STUDIES

TRACHEAL STENOSIS

Tracheal stenosis affects 4-13 % of adults

1-8 % of neonates after prolonged intubation .

adult tracheal stenosis : trauma, chronic inflammatory diseases, benign neoplasm, malignant neoplasm and collagen vascular diseases.

TRACHEAL STENOSIS

The most common cause of tracheal stenosis trauma, which can be internal (prolonged

endotracheal intubation, tracheostomy, flame burn injury) or external (blunt or penetrating

90 % of all cases of acquired chronic subglottic stenosis in children and adults result from endotracheal intubation or tracheostomy.1

TRACHEAL STENOSIS

TRACHEAL STENOSIS

TRACHEAL BRONCHUS A right upper bronchus

originating in the trachea

a variety of bronchial anomalies arising in the trachea or main bronchus, directed toward the upper-lobe territory.

The right lateral wall of the trachea less than 2 cm above the major carina , supply the entire upper lobe or its apical segment.

Tracheal bronchus may be displaced or supernumerary .

TRACHEAL BRONCHUS

TRACHEOBRONCHOMALACIA

An abnormal collapse of tracheal and bronchial walls on expiration.

Primary : intrinsic to the tracheobrochial tree.

Bronchoscopy

Cartilage to membrane ratio 4.5:1 to 2:1

Premature infant.

TRACHEOBRONCHOMALACIA Secondary: extrinsic pathologies, compression or damage to the

airway Esophageal atresia/ tracehobronchial

fistula A vascular anomaly A congenital cardiac defect Cystic lesion, bronchogenic cyst.

TRACHEOESOPHAGEAL FISTULA

A congenital or acquired communication between the trachea and esophagus.

Often lead to severe and fatal pulmonary complications.

Most patients with TEF are diagnosed immediately following birth or during infancy (neonatal period).

TRACHEOESOPHAGEAL FISTULA

Acquired TEF secondary to malignant disease. Infection, ruptured diverticula, trauma.

17-70% children with TEF have associated developmental anomalies.

Down syndrome, duodenal atresia, cardiovascular defect

TRACHEOESPHAGEAL FISTULA

Copious, fine white frothy bubbles of mucus in the mouth and nose.

Secretion recur despite suctioning

Rattling respiration, episode of coughing and choking associated with cyanosis.

Worsen during feeding

Abdominal distension

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