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Tracheomalacia - acquired

Acquired tracheomalacia is a weakness and floppiness of the walls of the windpipe (trachea) that develops after birth.

See also: Congenital tracheomalacia

Alternative Names

Secondary tracheomalacia

Causes

Acquired tracheomalacia is very uncommon. Rarely, babies, infants, and adults may develop the condition. It occurs when normal cartilage in the wall of the windpipe begins to break down.

Acquired, or secondary, tracheomalacia may result:

  • From pressure on the airway by large blood vessels
  • As a complication after surgical repair of a tracheo-esophagela fistula or esophageal atresia
  • After having a breathing tube or tracheostomy for a long time

Symptoms

  • Breathing problems that get worse with coughing, crying, or upper respiratory infections
  • Breathing noises that may change with position and improve during sleep
  • High-pitched breathing
  • Rattling, noisy breaths

Exams and Tests

A physical examination confirms the symptoms. A chest x-ray may show narrowing of the trachea when breathing out. Even if the x-ray is normal, it is needed to rule out other problems.

A procedure called a laryngoscopy is used to diagnose the condition. This procedure allows the otolaryngologist (ear, nose, and throat doctor, or ENT) to see the structure of the airway and determine how severe the problem is.

Other tests that may be performed include:

  • Airway fluoroscopy
  • Barium swallow
  • Bronchoscopy
  • CT scan
  • Lung function tests
  • Magnetic resonance imaging (MRI)

Treatment

The condition may improve without treatment, but persons with tracheomalacia must be monitored closely when they have respiratory infections.

Continuous positive airway pressure (CPAP) may be necessary for adults with respiratory distress. Rarely, surgery is needed. A stent may be needed to hold the airway.

Complications

Aspiration pneumonia can occur from breathing in food.

Adults who develop tracheomalacia after being on a breathing machine often have serious lung problems.

When to Contact a Medical Professional

Call your health care provider if you or your child breathes in an abnormal way. It can become an urgent or emergency condition.

References

Gaissert HA, Burns J. The compromised airway: tumors, strictures, and tracheomalacia. Surg Clin North Am. 2010; 90(5):1065-1089.

Licameli GR, Richardson MA. Diagnosis and management of tracheal anomalies and tracheal stenosis. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 207.

Updated: 5/10/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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