Down syndrome is a common chromosomal abnormality associated with many different structural anomalies. Tracheomalacia results in tracheal collapse when increased airflow is demanded due to the flaccidity of the tracheal support cartilage. Sufficient research and data are currently not available on airway malformations associated with Down syndrome, including tracheomalacia. In this case report, we discuss a Down syndrome patient with pneumonia found to have narrowing of his airway which resulted in prolonged hospital stay and difficulty in management. In most children with Down syndrome, tracheomalacia, tracheobronchomalacia, and bronchomalacia are all under diagnosed, yet these anomalies are more commonly missed in adults with Down syndrome. This can result from the patient's presentation, which tends to be non-specific, and unless a specific obstruction is considered, it is unlikely that such forms of narrowing will be discovered. Severe adult tracheomalacia is a severe condition that can be difficult to treat, especially when associated with an airway infection that may result in increased mortality rates.
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