Tracheobronchial

pathology
Dr. Rahmanofa Yunizaf
Endoscopy-Bronchoesophagology
Division
ENT 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
improves by age 612 months.

the

airway

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 DISEASE

THE 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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