Tracheomalacia

This presentation discusses tracheomalacia

1. Tracheomalacia

Dr T Balasubramanian

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2. Definition

This condition is defined as abnormal collapse of tracheal walls
during inspiration

The term “Malacia” means softening (Greek)
* These patients have widening of the posterior tracheal wall causing
a reduction in the antero posterior diameter.

Obstructionis caused either during inspiration / expiration
depending on the site of the lesion
* Flaccidity of tracheal cartilages ++

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3. ° Primary
+ Secondary

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4. * Occurs due to abnormal development of tracheal cartilage

» Lesions involving the extrathoracic portions cause
obstruction during inspiration

* Lesions involving the intrathoracic portion cause
obstruction during expiration

Primary tracheomalacia

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5. + Occurs in conjunction with conditions that compress the
airway

+ Source of compression could be mediastinal mass,
vascular arches, malformations compressing the trachea

+ Thyroid malignancies can cause tracheomalacia

+ Chronic aspiration in children can cause tracheomalacia

Secondary
tracheomalacia

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6. + Itcommonly affects the distal third of trachea

* Trachea is capable of changing its configuration during
the phases of respiration. Dilatation & lengthening occurs
during inspiration and narrowing and shortening occurs
during expiration

+ Accentuation of this normal expiratory phase may cause
tracheomalacia

+ Tracheomalacia not only interferes with breathing but
also impairs mucous clearance

Pathophysiology

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7. + Primary tracheomalacia is common in infants

+ Becomes better as the child grows

* These children are known as “Happy wheezers” as their
growth is not compromised due to wheeze as the oxygen
levels are maintained

+ This is not so in a child suffering from childhood asthma /
cystic fibrosis

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8. ° Type I — Congenital / intrinsic tracheal anomalies
associated with tracheo oesophageal fistula

+ Type II — Extrinsic defects / abnormal vascular rings
causing extrinsic compression of trachea

+ Type III — Acquired tracheomalacia due to prolonged
intubation / tracheitis etc.

Types of tracheomalacia

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9. » Laryngomalacia

° Subglottic stenosis

« Bilateral abductor palsy

* Congenital cysts of trachea

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10. + X-ray chest — Hyperinflation / tracheal narrowing during
expiration

+ Vascular anomalies like double aortic arch can be
demonstrated in the X-ray chest.

+ Dynamic expiratory CT scan — diagnostic

Cinefluroscopy with contrast in the oesophagus
demonstrate tracheomalacia

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11. Conservative / supportive

Bronchodilators — contraindicated. Relaxed tracheal
muscles worsen the condition

+ Chest physiotherapy — to clear retained secretions
+ Reflux oesophagitis — Managed aggressively

Continuous positive pressure ventilation

Stenting may be resorted to in extreme cases

Tracheostomy may help to stent a proximal
tracheomalacia

Management

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12. + Failure to gain weight
+ Recurrent episodes of pneumonia / apnoea
+ Airway obstruction needing long term support

Indications for stenting

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13. THANK YOU

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