Pediatric tracheomalacia

Abstract

Central airway malacia can affect the trachea and/or the main bronchi, making their walls susceptible to collapse during the respiratory cycle. It can be classified as primary or secondary, and clinically presents with recurrent or persistent respiratory symptoms (especially on expiration), recurrent infections and in severe cases, episodes of hypo- ventilation with cyanosis. The diagnosis is established by flexible or rigid bronchoscopy; imaging studies are considered as complementary, especially in cases of unclear diag­nosis, secondary causes or for preoperative planning. Treatment depends on different factors such as the severity of the symptoms, their etiology, location and extension. In mild cases, active observation and medical treatment waiting for spontaneous resolu- tion may be enough, which usually occurs in the first 2 years of age. In moderate cases, positive pressure ventilation could be useful. In severe cases, surgical treatment is indi- cated. Different techniques aiming to provide support to the weakened tracheobronchial structures are available, including tracheostomy, direct (tracheopexies) or indirect sus- pensions (aortopexy), external splints and intraluminal stents. In this article we present the main etiologies and available treatments for pediatric tracheomalacia. Given that diagnosis and management of these patients is complex, the work of multidisciplinary teams familiar with this pathology is of paramount importance.