Clinical presentation and airway management of tracheal atresia: A systematic review

Smith, Mariana Magnus; Huang, Amy; Labbé, Mathilde; Lubov, Joshua; Nguyen, Lily H. P.

doi:10.1016/j.ijporl.2017.07.028

Cited by 27 publications

(31 citation statements)

References 84 publications

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“…It is usually diagnosed prenatally because a CHAOS occurs. In presence of TOF, CHAOS doesn't develop and the diagnosis is made at birth when the neonate shows a severe respiratory distress that is shortly followed by cardio-respiratory arrest [4]. When a TOF is associated with TA, polyhydramnios and diffusely increased echogenicity of the lungs are the only signs possibly detected by prenatal ultrasonography [5,6].…”

Section: Introductionmentioning

confidence: 99%

Unexpected tracheal agenesis with prenatal diagnosis of aortic coarctation, lung hyperecogenicity and polyhydramnios: a case report

et al. 2020

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Background: Tracheal agenesis (TA) is a rare disorder usually diagnosed prenatally when a congenital high airway obstruction syndrome (CHAOS) is identified. We present a case of unexpected TA in a neonate without prenatal diagnosis of airway obstruction, with a difficult management at birth. Moreover, we discuss about differential diagnosis, classification and treatment issues. Case presentation: A 2280 g female neonate was born at 35 week gestational age (GA) with prenatal diagnosis of aortic coarctation, polyhydramnios and diffuse hyperechogenicity of the right lung. At birth, the neonate had no audible cry, no air entry to the lungs, and hypotonia. Tracheal intubation was unsuccessful, and no visualization of the trachea was obtained when tracheostomy was attempted. Post-mortem examination showed tracheal agenesis associated with tracheoesophageal fistula and revealed no cardiologic malformations. Aortic coarctation had been suspected prenatally because of the first portion of the descendent thoracic aorta being compressed by a fibrous band connecting the proximal and distal tracheal branches. CHAOS had not developed due to the tracheoesophageal fistula (TOF). Conclusions: TA is not always diagnosed in the fetus and it may present unexpectedly making the neonate's management at birth critical. An effective rescue temporary oxygenation may be obtained with mask ventilation or oesophageal intubation in those cases of TA associated with a TOF. We suggest to consider a fetal magnetic resonance imaging (MRI) when the association polyhydramnios/lung hyperechogenicity occurs, even in the absence of CHAOS or other malformations. Once a diagnosis is provided, the mother should be transferred to selected centres where an ex-utero intrapartum procedure (EXIT) can be attempted. Moreover, despite high mortality, different surgical management are described to improve survival.

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Section: Introductionmentioning

confidence: 99%

Unexpected tracheal agenesis with prenatal diagnosis of aortic coarctation, lung hyperecogenicity and polyhydramnios: a case report

et al. 2020

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“…However, the prenatal diagnosis is difficult and only few cases have been reported. Thus, 149 cases were reported [3] . Among the reported cases, mortality was estimated at of 85% [2] .…”

Section: Discussionmentioning

confidence: 99%

Tracheal agenesis clinical presentation in a preterm infant: Prenatal MRI difficulties and autopsy findings

Saadi

Abdeljelil

Salem

et al. 2020

Radiology Case Reports

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We describe, the clinical presentation of a rare case of Tracheal Agenesis in a preterm infant and we highlight magnetic imaging resonance (MRI) and autopsy findings to better characterize this anomaly. A 30-year-old female presented for acute polyhydramnios at 30 weeks gestation of a male foetus. Prenatal MRI was performed and excluded this diagnosis. After delivery, the neonate presented a respiratory distress. The laryngoscopy control of tube position concluded to an esophageal intubation. A second reading of antenatal MRI was made. An autopsy was performed. The internal examination of the organs revealed broncho-oesophageal fistula. The upper airways were obstructed at the larynx. Fetal MRI should be interpreted with caution when Tracheal Agenesis is highly suspected.

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“…[2,3] Fetal surgery and EXIT are options to manage CHAOS, but prenatal diagnosis is essential to planning and only 2.3% of cases of TA are diagnosed prenatally. [1] For patients who are not candidates for intrauterine intervention, EXIT remains the option with the best chance of survival. [3] The objective is to evaluate and secure an airway below the level of obstruction, while utero-placental gas exchange is preserved.…”

Section: Dear Sirmentioning

confidence: 99%

“…Surgical management, then, consists of esophageal ligation distal to the TEF, proximal esophagostomy (to drain saliva) and feeding gastrostomy until reconstruction can be planned. [1] If the intubation fails, a tracheostomy should be attempted, but success depends on finding tracheal tissue that can be intubated. [5] A systematic review by Smith et al found that the mortality rate is 92.6% at 1 year, and none of the 7 cases without TEF survived more than 24 hours.…”

Section: Dear Sirmentioning

confidence: 99%

See 1 more Smart Citation

Prenatal Diagnosis Of Congenital High Airway Obstruction Syndrome

Costa¹,

Oliveira²,

Miyasaki³

2018

J Neonat Surg

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Clinical presentation and airway management of tracheal atresia: A systematic review

Cited by 27 publications

References 84 publications

Unexpected tracheal agenesis with prenatal diagnosis of aortic coarctation, lung hyperecogenicity and polyhydramnios: a case report

Unexpected tracheal agenesis with prenatal diagnosis of aortic coarctation, lung hyperecogenicity and polyhydramnios: a case report

Tracheal agenesis clinical presentation in a preterm infant: Prenatal MRI difficulties and autopsy findings

Prenatal Diagnosis Of Congenital High Airway Obstruction Syndrome

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