391 a Aberrant Right Subclavian Artery , 118 Absent Tracheal Rings

Total Page:16

File Type:pdf, Size:1020Kb

391 a Aberrant Right Subclavian Artery , 118 Absent Tracheal Rings Index A Airway obstruction Aberrant right subclavian artery , 118 diagnosis , 175 Absent tracheal rings , 84 extrinsic Accreditation Council for Graduate Medical Education bronchogenic cyst , 172–174 (ACGME) , 346 cervical lymphangioma , 169, 171–172 Acquired lobar emphysema , 252 cervical teratoma , 172–173 Acquired subglottic stenosis congenital epulis , 168, 170 adjuvant endoscopic therapy , 61 cystic pulmonary airway malformations , 174 anterior cricoid split , 61 epignathus , 167–169 clinical presentation , 59 evaluation and intervention , 174–175 cricotracheal resection , 61–62 intra-thoracic teratoma , 173 diagnosis and management , 60 micrognathia , 168–171 endoscopic balloon dilation , 61 ex utero intrapartum treatment , 177–178 epidemiology , 59 fetal MRI , 177 laryngotracheal reconstruction , 61–62 intrinsic , 175–176 medical management , 60 postnatal management , 178–179 pathogenesis , 59–60 ultrasound and differential diagnosis , 168, 177 tracheostomy , 62 Airway safety program , 385–386 Aerodigestive tract , 59 Airway safety rounds , 387–388 Aftab, S. , 307–317 Airway training Airtraq™ , 232–233 bag mask ventilation , 348–350 AirwayCart , 302 cadaver and animal airway models , 348 Airway emergencies conjoined twin intubation , 348–349 cricothyroidotomy , 303 debriefi ng , 358–359 direct/indirect laryngoscopy equipment diffi cult airway management simulation , 354–356 fi ber optic , 302–303 educational venues , 357 neonatal laryngoscope , 303 high fi delity simulation center , 347 education/simulation , 300 infant care providers , 346 neonatal specifi c algorithms , 297–299 intubation training , 350–353 noninvasive equipment manikin modifi cations , 348 bag mask ventilation , 300 Neonatal Resuscitation Program , 346 laryngeal mask airway , 301–302 nontechnical skills training , 356–357 nasal pharyngeal airways , 301 Pediatric Residency Review Committee , 345 quality improvement physician training , 345 airway safety program , 385–386 side-lying intubation , 348–349 airway safety rounds , 387–388 simulation outcome measurement , 357–358 emergency airway tracking sheet , 386–387 task trainer model , 346–347 high reliability organizations , 385 tracheostomy training , 353–354 live communication , 385 video enhanced laryngoscopy , 353 patient safety , 389 Akinbi, H. , 263–277 perioperative communications , 387 Alpha feto protein (AFP) , 172 strategy implementation American Society of Anesthesiologists (ASA) , 223 anticipation , 297 Anderson, J. , 25–33 execution , 298, 300 Andreoli, S. , 121–130 identifi cation , 298 Anesthesia mobilization , 298 intraoperative management preparation , 298 AirQ® , 227 Airway fl uoroscopy , 202 Airtraq camera , 228 neonatal stridor , 195 ASA diffi cult airway algorithm , 224–225 tracheobronchomalacia evaluation , 201 CHOP diffi cult airway algorithm , 224, 226 J. Lioy and S.E. Sobol (eds.), Disorders of the Neonatal Airway: Fundamentals for Practice, 391 DOI 10.1007/978-1-4939-1610-8, © Springer Science+Business Media New York 2015 392 Index Anesthesia (cont.) Chest X-ray (CXR) , 252 drugs , 224, 227 Choanal atresia , 135 laryngeal mask airways , 224, 226 clinical presentation , 6–7, 122 micrognathia anesthesia , 223 considerations , 8, 122 Rendell–Baker mask , 226 diagnosis , 7, 122 rescue device , 226, 227 epidemiology , 6, 121 sedation regimen comparison , 224, 227 etiology , 4, 6, 121 video and optical laryngoscopes , 229–234 genetic disorders , 159–160 postoperative management , 234 management , 7, 122 preoperative preparation pathogenesis , 6–7, 122 abnormal anatomy and physiology , 222–223 posterior , 37–38 normal anatomy and physiology , 221–222 surgical challenges , 238–239 rapid sequence intubation , 222 CHOP diffi cult airway algorithm , 224, 226 role of anesthesiologist , 234–235 Chorionic villus sampling (CVS) , 98, 150 Anterior cricoid split (ACS) , 61 Chuo, J. , 385–389 Antley–Bixler syndrome , 157 CNPAS. See Congenital nasal pyriform aperture stenosis (CNPAS) Aortopexy , 93 Com, G. , 271 Apert, E. , 27 Complete high airway obstruction syndrome (CHAOS) , 126 Apert syndrome , 17–18, 147–148 Complete tracheal rings (CTRs) , 21–22, 82, 127–128 clinical presentation , 27 Computed tomography (CT) , 253–254 diagnosis , 27 advantages , 202–203 epidemiology , 27 curved planar reformatting , 203 etiology , 27 external rendering method , 203 management , 27 minimum intensity projection , 203 multidisciplinary consideration , 28 neonatal stridor , 196–197 pathogenesis , 27 techniques , 203 Arrhinia. See Congenital arhinia volume rendering method , 203, 204 ASA diffi cult airway algorithm , 224–225 Congenital airway disorders in larynx clefts , 8–10 B congenital subglottic stenosis , 11–12 Bag mask ventilation (BMV) , 300, 348–350 laryngeal webs and atresia , 10–11 Baxter, J.D. , 87, 89 in nasal Beattie, C. , 234 choanal atresia , 4, 6–8 Beckwith Weidmann syndrome , 136 congenital nasal piriform aperture stenosis , 3–6 Benjamin, B. , 9, 89 in trachea , 12–13 Berg, E.E. , 87–94 Congenital arhinia , 36 Bethanechol , 93 Congenital cystic adenomatoid malformation (CCAM) , 187 Bhutani, V.K. , 252 Congenital epulis , 168, 170 Bifi d epiglottis , 123–124, 161–162 Congenital high airway obstruction syndrome (CHAOS) Bilateral choanal atresia , 37 clinical presentation , 64 Bilateral vocal cord paralysis , 125, 263, 265 diagnosis and management , 64–65 Biomarkers , 285 epidemiology , 64 Biphasic stridor , 189 multidisciplinary considerations , 65 Birth trauma , 36 pathogenesis , 64 Blair, G.K. , 89 Congenital laryngomalacia Blinman, T. , 281–292 clinical presentation , 52–53 Bronchioalveolar lavage (BAL) , 216 diagnosis , 52–54 Bronchogenic cyst , 172–174 epidemiology , 52–53 Bronchomalacia , 87, 253 etiology , 51–52 Bronchoscopes , 215–217 management , 54–55 Bronchoscopy , 255, 284–285 multidisciplinary considerations Bucher, U. , 248 cardiac disease , 56 Burke, R.P. , 119 congenital anomalies and genetic disorders , 56 Busato, G.-M. , 3–13 gastrointestinal disease , 55–56 neurologic disease , 56 pathogenesis , 51–52 C Congenital malformations Campisi, P. , 3–13 acquired abnormalities , 207 Cardiac disease , 56 branching anomalies , 205 Cervical lymphangioma , 169, 171–172 congenital tracheal stenosis , 205–206 Cervical teratomas , 172–173, 181–182, 240 developmental anomalies , 205 CHAOS. See Congenital high airway obstruction syndrome (CHAOS) vascular compression , 206–207 CHARGE syndrome , 17 Congenital nasal pyriform aperture stenosis (CNPAS) Chaudhry, A.P. , 30 clinical presentation , 4, 15 Cheng, J. , 67–74 diagnosis , 4, 6, 15–16 Chest radiographs , 195, 196, 201–202 epidemiology , 3, 15 Index 393 etiology , 3, 15 multidisciplinary consideration , 18 management , 4, 16 pathogenesis , 18 multidisciplinary consideration , 4–6, 17 Cricoid cartilage , 138 pathogenesis , 3–5, 15 Cricothyroidotomy , 303 Congenital pharyngeal mass , 239 Cricotracheal resection (CTR) , 61–62 Congenital pyriform sinus aperture stenosis , 135 Crisis resource management , 357 Congenital subglottic stenosis Critically ill neonate transportation clinical presentation , 11–12, 63 acute decompensations , 341 diagnosis , 12, 63 advanced airway and ventilation , 340–341 epidemiology , 11, 62 ambulance/aircraft , 335–336 etiology , 11 consent , 334 grade III–IV lesions , 63 considerations , 332–333 grade I–II lesions , 63 EMTALA , 319–320 management , 12 fi xed-wing transports , 337–339 multidisciplinary considerations , 63–64 ground transport considerations , 335–336 pathogenesis , 11, 62–63 initial triage , 330–331 Congenital tracheal cartilaginous sleeve , 164 isolette transfer , 334–335 Congenital tracheal stenosis medical records and consents , 322 clinical presentation , 12 mode of transport , 320–322 absent tracheal rings , 84 parental accompaniment , 334–335 biphasic stridor , 81 pre-dispatch preparation , 331–332 complete tracheal rings , 82 pre-hospital decision-making , 320 diagnostic workup , 82–83 referring hospital , 334 sleeve trachea , 83–84 rotor-wing transport considerations , 336–337 considerations , 12–13, 85–86 sedation and paralysis , 339–340 diagnosis , 12–13 team composition , 320–321 epidemiology , 12, 81 transfer of responsibility , 322 etiology , 12 unstable tracheostomy , 341–342 management , 12, 84–85 Crombleholme, T.M. , 167–179 overview , 81 Crouzon, O. , 26 pathogenesis , 12 Crouzon syndrome , 17–18, 147–148 Consolidated Omnibus Budget Reconciliation Act (COBRA) , 319 clinical presentation , 26–27 Continuous positive airway pressure (CPAP) , 92–93 diagnosis , 27 Contrast esophagogram , 201 epidemiology , 26 Contrast esophagography , 202 etiology , 26 Contrast esophagrams , 196 management , 27 Coppit, G.L. , 30 multidisciplinary considerations , 27 Corbett , 266 pathogenesis , 26 Cotton, R.T. , 60 Curved planar reformatting (CPR) , 203 Cough , 79 Cystic pulmonary airway malformations Craniofacial microsomia (CPAMs) , 174 clinical presentation , 20 diagnosis , 20 epidemiology , 20 D etiology , 20 da Silva, O.P. , 59 management , 20 Dacryocystocele. See Nasolacrimal duct cyst multidisciplinary consideration , 20–21 Darrow, D.H. , 97–108 pathogenesis , 20 deAlarcón, A. , 81–86 Craniofacial syndromes DeMauro, S.B. , 263–277 laryngotracheal Derkay, C. , 209–220 Down syndrome , 21–22 Deshmuhk, H. , 133–143 tracheal cartilaginous sleeve , 22–23 Deshmunkh, H. , 297–303 nasal cavity and midface Diffi cult airway management simulation , 354–356 CHARGE syndrome , 17 Direct laryngoscopy/bronchoscopy , 194–195 CNPAS , 15–17 Downing, G.J. , 246 craniosynostosis syndrome , 17–18 Down syndrome oromandibular clinical
Recommended publications
  • Current Management and Outcome of Tracheobronchial Malacia and Stenosis Presenting to the Paediatric Intensive Care Unit
    Intensive Care Med 52001) 27: 722±729 DOI 10.1007/s001340000822 NEONATAL AND PEDIATRIC INTENSIVE CARE David P.Inwald Current management and outcome Derek Roebuck Martin J.Elliott of tracheobronchial malacia and stenosis Quen Mok presenting to the paediatric intensive care unit Abstract Objective: To identify fac- but was not related to any other fac- Received: 10 July 2000 Final Revision received: 14 Oktober 2000 tors associated with mortality and tor. Patients with stenosis required a Accepted: 24 October 2000 prolonged ventilatory requirements significantly longer period of venti- Published online: 16 February 2001 in patients admitted to our paediat- latory support 5median length of Springer-Verlag 2001 ric intensive care unit 5PICU) with ventilation 59 days) than patients tracheobronchial malacia and with malacia 539 days). stenosis diagnosed by dynamic con- Conclusions: Length of ventilation Dr Inwald was supported by the Medical Research Council. This work was jointly trast bronchograms. and bronchographic diagnosis did undertaken in Great Ormond Street Hos- Design: Retrospective review. not predict survival. The only factor pital for Children NHSTrust, which re- Setting: Tertiary paediatric intensive found to contribute significantly to ceived a proportion of its funding from the care unit. mortality was the presence of com- NHSExecutive; the views expressed in this Patients: Forty-eight cases admitted plex cardiac and/or syndromic pa- publication are those of the authors and not to our PICU over a 5-year period in thology. However, patients with necessarily those of the NHSexecutive. whom a diagnosis of tracheobron- stenosis required longer ventilatory chial malacia or stenosis was made support than patients with malacia.
    [Show full text]
  • The Role of Larygotracheal Reconstruction in the Management of Recurrent Croup in Patients with Subglottic Stenosis
    International Journal of Pediatric Otorhinolaryngology 82 (2016) 78–80 Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo urnal homepage: www.elsevier.com/locate/ijporl The role of larygotracheal reconstruction in the management of recurrent croup in patients with subglottic stenosis a,b,c, a,b a,d,e Bianca Siegel *, Prasad Thottam , Deepak Mehta a Department of Pediatric Otolaryngology, Childrens Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA b Children’s Hospital of Michigan, Detroit, MI, USA c Wayne State University School of Medicine Department of Otolaryngology, Detroit, MI, USA d Texas Children’s Hospital, Houston, TX, USA e Baylor University School of Medicine Department of Otolaryngology, Houston, TX, USA A R T I C L E I N F O A B S T R A C T Article history: Objectives: To determine the role of laryngotracheal reconstruction for recurrent croup and evaluate Received 16 October 2015 surgical outcomes in this cohort of patients. Received in revised form 4 January 2016 Methods: Retrospective chart review at a tertiary care pediatric hospital. Accepted 6 January 2016 Results: Six patients who underwent laryngotracheal reconstruction (LTR) for recurrent croup with Available online 13 January 2016 underlying subglottic stenosis were identified through a search of our IRB-approved airway database. At the time of diagnostic bronchoscopy, all 6 patients had grade 2 subglottic stenosis. All patients were Keywords: treated for reflux and underwent esophageal biopsies at the time of diagnostic bronchoscopy; 1 patient Laryngotracheal reconstruction had eosinophilic esophagitis which was treated. All patients had a history of at least 3 episodes of croup Recurrent croup in a 1 year period requiring multiple hospital admissions.
    [Show full text]
  • Subglottic Stenosis: Current10.5005/Jp-Journals-10001-1272 Concepts and Recent Advances Review Article
    IJHNS Subglottic Stenosis: Current10.5005/jp-journals-10001-1272 Concepts and Recent Advances REVIEW ARTICLE Subglottic Stenosis: Current Concepts and Recent Advances 1Oshri Wasserzug, 2Ari DeRowe ABSTRACT Signs and Symptoms Subglottic stenosis is considered one of the most complex and The symptoms of SGS in children are closely related to challenging aspects of pediatric otolaryngology, with the most the degree of airway narrowing. Grade I SGS is usually common etiology being prolonged endotracheal intubation. The asymptomatic until an upper respiratory tract infection surgical treatment of SGS can be either endoscopic or open, but recent advances have pushed the limits of the endoscopic occurs, when respiratory distress and stridor, which are approach so that in practice an open laryngotracheal surgical the hallmarks of SGS, appear. Grades II and III stenosis approach is considered only after failed attempts with an can cause biphasic stridor, air hunger, dyspnea, and endoscopic approach. In this review we discuss these advances, suprasternal, intercostal, and diaphragmatic retractions. along with current concepts regarding the diagnosis and Prolonged or recurrent episodes of croup should raise treatment of subglottic stenosis in children. suspicion for SGS. Keywords: Direct laryngoscopy, Endoscopic surgery, Laryngo- At times, the appearance of SGS may be insidious and tracheal surgery, Prolonged intubation, Subglottic stenosis. progressive. It is important to recognize that a compro- How to cite this article: Wasserzug O, DeRowe A. Subglottic Stenosis: Current Concepts and Recent Advances. Int J Head mised airway in a child can lead to rapid deterioration Neck Surg 2016;7(2):97-103. and require immediate appropriate intervention to avoid Source of support: Nil a catastrophic outcome.
    [Show full text]
  • Stridor in the Newborn
    Stridor in the Newborn Andrew E. Bluher, MD, David H. Darrow, MD, DDS* KEYWORDS Stridor Newborn Neonate Neonatal Laryngomalacia Larynx Trachea KEY POINTS Stridor originates from laryngeal subsites (supraglottis, glottis, subglottis) or the trachea; a snoring sound originating from the pharynx is more appropriately considered stertor. Stridor is characterized by its volume, pitch, presence on inspiration or expiration, and severity with change in state (awake vs asleep) and position (prone vs supine). Laryngomalacia is the most common cause of neonatal stridor, and most cases can be managed conservatively provided the diagnosis is made with certainty. Premature babies, especially those with a history of intubation, are at risk for subglottic pathologic condition, Changes in voice associated with stridor suggest glottic pathologic condition and a need for otolaryngology referral. INTRODUCTION Families and practitioners alike may understandably be alarmed by stridor occurring in a newborn. An understanding of the presentation and differential diagnosis of neonatal stridor is vital in determining whether to manage the child with further observation in the primary care setting, specialist referral, or urgent inpatient care. In most cases, the management of neonatal stridor is outside the purview of the pediatric primary care provider. The goal of this review is not, therefore, to present an exhaustive review of causes of neonatal stridor, but rather to provide an approach to the stridulous newborn that can be used effectively in the assessment and triage of such patients. Definitions The neonatal period is defined by the World Health Organization as the first 28 days of age. For the purposes of this discussion, the newborn period includes the first 3 months of age.
    [Show full text]
  • ERS Statement on Tracheomalacia and Bronchomalacia in Children
    ERS OFFICIAL DOCUMENT ERS STATEMENT ERS statement on tracheomalacia and bronchomalacia in children Colin Wallis1,EfthymiaAlexopoulou2,JuanL.Antón-Pacheco3,JayeshM.Bhatt 4, Andrew Bush5,AnneB.Chang6,7,8,Anne-MarieCharatsi9, Courtney Coleman10, Julie Depiazzi11, Konstantinos Douros12,ErnstEber13,MarkEverard14, Ahmed Kantar15,IanB.Masters6,7,FabioMidulla16, Raffaella Nenna 16,17, Derek Roebuck18, Deborah Snijders19 and Kostas Priftis12 @ERSpublications This statement provides a comprehensive review of the causes, presentation, recognition and management of children with tracheobronchomalacia written by a multidisciplinary Task Force in keeping with ERS methodology http://bit.ly/2LPTQCk Cite this article as: Wallis C, Alexopoulou E, Antón-Pacheco JL, et al. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54: 1900382 [https://doi.org/10.1183/13993003.00382- 2019]. ABSTRACT Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit.
    [Show full text]
  • A Case of Tracheal Stenosis As an Isolated Form of Immunoproliferative Hyper-Igg4 Disease in a 17-Year-Old Girl
    children Case Report A Case of Tracheal Stenosis as an Isolated Form of Immunoproliferative Hyper-IgG4 Disease in a 17-Year-Old Girl Natalia Gabrovska 1,*, Svetlana Velizarova 1, Albena Spasova 1, Dimitar Kostadinov 1, Nikolay Yanev 1, Hristo Shivachev 2, Edmond Rangelov 2, Yanko Pahnev 2, Zdravka Antonova 2, Nikola Kartulev 2, Ivan Terziev 3 and Kaloyan Gabrovski 4 1 Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; [email protected] (S.V.); [email protected] (A.S.); [email protected] (D.K.); [email protected] (N.Y.) 2 Department of Pediatric Thoracic Surgery, Pediatric Surgery Clinic, University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov”, 1606 Sofia, Bulgaria; [email protected] (H.S.); [email protected] (E.R.); [email protected] (Y.P.); [email protected] (Z.A.); [email protected] (N.K.) 3 Department of Pathology, University Hospital ‘’Tsaritsa Uoanna–ISUL”, 1527 Sofia, Bulgaria; [email protected] 4 Department of Neurosurgery, University Hospital “St. Ivan Rilski”, Medical University–Sofia, 1431 Sofia, Bulgaria; [email protected] * Correspondence: [email protected]; Tel.: +359-887-931-009 Abstract: Immunoglobulin G4-related disease (IgG4-RD) is a lymphoproliferative disease which is described almost exclusively in adults. There are only a few pediatric patients who have been observed with this disorder. Here, we describe a rare case of IgG4-RD in a 17-year-old girl with Citation: Gabrovska, N.; Velizarova, a single manifestation—tracheal stenosis without previous intubation or other inciting event.
    [Show full text]
  • 7-Nose II.Docx ( Updated F1 )
    1 [Color index: Important | Notes | Extra] Editing ​ ​ ​ ​ ​ ​ ​ ​ 2 Diseases of the nose Supernumerary nostril Midline nasal sinus: Nasal clefts: Proboscis lateralis: Incomplete fusion of the right Failure of frontal nasal Due to imperfect fusion and left medial nasal process to develop between the maxillary process prominence. appropriately results into and the lateral nasal process. two separated halves of the nose. Polyrrhinia: Arrhinia: due to bilateral Half nose: due to unilateral absence of nasal placode ​ ​ Duplication of the medial nasal absence of nasal placodes. processes. This is serious because the newborn is a nose breather. mouth breathing is a learning process. Atresia of posterior nares ❖ Types: ● Bony (most commonly) ● Membranous ● Mixed ● Complete unilateral (most commonly) ● Complete bilateral surgical emergency ​ ● Incomplete unilateral ● Incomplete bilateral ❖ Diagnosis: ● Total absence of nasal air flow ● Plastic catheter cannot be passed through the nose ● Post-rhinoscopy ● Radiographs 3 ● Emergency ● Transnasal perforation ● Trans-palatal excision ❖ Management: ﻧﻔﺘﺢ ﻓﻤﻪ ﻓﯿﻀﻄﺮ ﯾﺘﻨﻔﺲ ﻣﻦ ﻓﻤﻪ (Put something to open the mouth (oral airway ● ● Perforate it If membranous ● Surgery (endoscopic) ● In bilateral it is an emergency, in unilateral it is not an emergency and we can wait until the child gains weight then we do surgery. ● Rhinitis refers to inflammatory changes in the nasal mucosa. As the nasal mucosa is continuous ​ ​ ​ ​ ​ ​ over the nose and sinuses, there is nearly always some inflammatory change in the sinuses as 1 well. Hence Rhinosinusitis is​ a better term. ● Types: - acute rhinitis (less than 4 weeks) - chronic rhinitis (more than four consecutive weeks) ● Types based on etiology: 1) Infectious rhinitis(viral/bacterial) 2)Non-allergic Rhinitis,Non-infectious rhinitis -Eosinophilic syndromes(Nares/Nasal polyposis) -NonEosinophilic syndromes(Vasomotor rhinitis/Rhinitis medicamentosa/occupational rhinitis/Rhinitis of pregnancy/hypothyroidism/Medication(OCP).
    [Show full text]
  • Respiratory Complications and Goldenhar Syndrome
    breathe case presentations.qxd 06/03/2007 17:56 Page 15 CASE PRESENTATION Respiratory complications and Goldenhar syndrome Case report W. Jacobs1 A 29-year-old female was referred to hospital A. Vonk Noordegraaf1 with progressive asthmatic complaints. On pre- R.P. Golding2 sentation, the patient had been experiencing J.G. van den Aardweg3 orthopnoea, an audible wheeze during daily P.E. Postmus1 activities, and sporadic coughing without spu- tum production. The patient had a history of recurrent airway infections and a 5-kg weight Depts of 1Pulmonary Medicine loss during the previous year, and had stopped and 2Radiology, Vrije Universiteit smoking several years before. She was known to Medisch Centrum, Amsterdam, have oculo-auriculo-vertebral (OAV) syndrome, and 3Dept of Pulmonary i.e. Goldenhar syndrome, which is a develop- Medicine, Medisch Centrum mental disorder involving mainly first and sec- Alkmaar, The Netherlands. ond branchial arch anomalies. On physical examination, she was not dys- pnoeic at rest, and had a respiratory rate of Correspondence: -1 -1 14 breaths·min , pulse 80 beats·min , blood W. Jacobs pressure 110/70 mmHg and temperature Dept of Pulmonary Medicine Figure 1 37.9°C. The left hemifacial structures and the Vrije Universiteit Medisch Centrum Postero-anterior chest radiograph. left hemithorax were underdeveloped. A chest Postbus 7057 examination revealed a systolic heart murmur 1007 MB Amsterdam grade 2/6 over the apex, and inspiratory and The Netherlands expiratory wheezing over both lungs. There was Task 1 Fax: 31 204444328 E-mail: [email protected] no oedema or clubbing. Arterial blood gas analy- Interpret the chest radiograph.
    [Show full text]
  • Tracheobronchomalacia and Excessive Dynamic Airway Collapse
    Blackwell Publishing AsiaMelbourne, AustraliaRESRespirology1323-77992006 Blackwell Publishing Asia Pty Ltd? 2006114388406Review ArticleTBM and EDACSD Murgu and HG Colt Respirology (2006) 11, 388–406 doi: 10.1111/j.1400-1843.2006.00862.x REVIEW ARTICLE Tracheobronchomalacia and excessive dynamic airway collapse Septimiu D. MURGU AND Henri G. COLT Pulmonary and Critical Care Medicine, Department of Medicine, University of California School of Medicine, Irvine, CA, USA Tracheobronchomalacia and excessive dynamic airway collapse MURGU SD, COLT HG. Respirology 2006; 11: 388–406 Abstract: Tracheobronchomalacia and excessive dynamic airway collapse are two separate forms of dynamic central airway obstruction that may or may not coexist. These entities are increasingly recognized as asthma and COPD imitators. The understanding of these disease processes, however, has been compromised over the years because of uncertainties regarding their definitions, patho- genesis and aetiology. To date, there is no standardized classification, diagnosis or management algorithm. In this article we comprehensively review the aetiology, morphopathology, physiology, diagnosis and treatment of these entities. Key words: airflow dynamics, bronchomalacia, excessive dynamic airway collapse, tracheobron- chomalacia, tracheomalacia. INTRODUCTION first is that most published studies are case series and retrospective descriptions, many of which report a The purpose of this systematic review is to clarify con- single investigator’s experience with diagnosis and founding issues pertaining to the definition, patho- management. In fact, it is puzzling that despite the physiology, histopathology, aetiology, diagnosis, relative frequency with which TBM and EDAC are pre- classification and treatment of acquired and idio- sumably encountered, multi-institutional or prospec- pathic forms of adult tracheobronchomalacia (TBM) tive studies have not been published.
    [Show full text]
  • Series of Laryngomalacia, Tracheomalacia, and Bronchomalacia Disorders and Their Associations with Other Conditions in Children
    Pediatric Pulmonology 34:189-195 (2002) Series of Laryngomalacia, Tracheomalacia, and Bronchomalacia Disorders and Their Associations With Other Conditions in Children I.B. Masters, MBBS, FRACP,1* A.B. Chang, PhD, FRACP,2 L. Patterson, MBBS, FANZCAC,1 С Wainwright, MD, FRACP,1 H. Buntain, MBBS,1 B.W. Dean, MSC,1 and P.W. Francis, MD, FRACP1 Summary. Laryngomalacia, bronchomalacia, and tracheomalacia are commonly seen in pediatric respiratory medicine, yet their patterns and associations with other conditions are not well-understood. We prospectively video-recorded bronchoscopic data and clinical information from referred patients over a 10-year period and defined aspects of interrelationships and associations. Two hundred and ninety-nine cases of malacia disorders (34%) were observed in 885 bronchoscopic procedures. Cough, wheeze, stridor, and radiological changes were the most common symptoms and signs. The lesions were most often found in males (2:1) and on the left side (1.6:1). Concomitant malacia lesions ranged from 24%forlaryngotracheobronchomalaciato 47% for tracheobronchomalacia. The lesions were found in association with other disorders such as congenital heart disorders (13.7%), tracheo-esophageal fistula (9.6%), and various syndromes (8%). Even though the understanding of these disorders is in its infancy, pediatricians should maintain a level of awareness for malacia lesions and consider the possibility of multiple lesions being present, even when one symptom predominates or occurs alone. Pediatr Pulmonol Pediatr Pulmonol. 2002; 34:189-195. © 2002 wiiey-Liss. inc. Key words: laryngomalacia; tracheomalacia; bronchomalacia; malacia disorders; syndromes. INTRODUCTION The aim of this report is to describe an extensive experience of various forms of laryngomalacia, tracheo­ Tracheomalacia, bronchomalacia, and laryngomalacia malacia, and bronchomalacia and explore some of the disorders are commonly seen in tertiary pediatric respira­ interrelationships that exist between these conditions with tory practice.
    [Show full text]
  • Adult Outcome of Congenital Lower Respiratory Tract Malformations M S Zach, E Eber
    500 Arch Dis Child: first published as 10.1136/adc.87.6.500 on 1 December 2002. Downloaded from PAEDIATRIC ORIGINS OF ADULT LUNG DISEASES Series editors: P Sly, S Stick Adult outcome of congenital lower respiratory tract malformations M S Zach, E Eber ............................................................................................................................. Arch Dis Child 2002;87:500–505 ongenital malformations of the lower respiratory tract relevant studies have shown absence of the normal peristaltic are usually diagnosed and managed in the newborn wave, atonia, and pooling of oesophageal contents.89 Cperiod, in infancy, or in childhood. To what extent The clinical course in the first years after repair of TOF is should the adult pulmonologist be experienced in this often characterised by a high incidence of chronic respiratory predominantly paediatric field? symptoms.910 The most typical of these is a brassy, seal-like There are three ways in which an adult physician may be cough that stems from the residual tracheomalacia. While this confronted with this spectrum of disorders. The most frequent “TOF cough” is both impressive and harmless per se, recurrent type of encounter will be a former paediatric patient, now bronchitis and pneumonitis are also frequently observed.711In reaching adulthood, with the history of a surgically treated rare cases, however, tracheomalacia can be severe enough to respiratory malformation; in some of these patients the early cause life threatening apnoeic spells.712 These respiratory loss of lung tissue raises questions of residual damage and symptoms tend to decrease in both frequency and severity compensatory growth. Secondly, there is an increasing with age, and most patients have few or no respiratory number of children in whom paediatric pulmonologists treat complaints by the time they reach adulthood.13 14 respiratory malformations expectantly; these patients eventu- The entire spectrum of residual respiratory morbidity after ally become adults with their malformation still in place.
    [Show full text]
  • Idiopathic Subglottic Stenosis: a Review
    1111 Editorial Section of Interventional Pulmonology Idiopathic subglottic stenosis: a review Carlos Aravena1,2, Francisco A. Almeida1, Sanjay Mukhopadhyay3, Subha Ghosh4, Robert R. Lorenz5, Sudish C. Murthy6, Atul C. Mehta1 1Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA; 2Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; 3Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, 4Department of Diagnostic Radiology, 5Head and Neck Institute, 6Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA Contributions: (I) Conception and design: C Aravena, AC Mehta; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: C Aravena, AC Mehta; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Atul C. Mehta, MD, FCCP. Lerner College of Medicine, Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, A-90, Cleveland, OH 44195, USA. Email: [email protected]. Abstract: Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies.
    [Show full text]