Tracheobronchomalacia

Abstract

The term tracheobronchomalacia refers to excessively compliant and collapsible central airways leading to symptoms. Although seen as a coexisting condition with various other pulmonary condition, it may cause symptoms by itself. The condition is often misdiagnosed as asthma, bronchitis or just chronic cough due to a lack of specific pathognomonic history and clinical findings. The investigation revolves around different modes of imaging, lung function testing and usually confirmed by flexible bronchoscopy. The treatment widely varies based on the cause, with most cases treated conservatively with non-invasive ventilation. Some may require surgery or stent placement. In this article, we aim to discuss the pathophysiology behind this condition and recognize the common symptoms and causes of tracheobronchomalacia. The article will highlight the diagnostic steps as well as therapeutic interventions based on the specific cause.

Thoracic Computed Tomography Scan and Bronchoscopy Appearance of Mounier-Kuhn Syndrome: A Case Report

“…Within the congenital causes appear dyschondroplasias, polychondritis, Ehlers-Danlos syndrome, Pierre-Robin syndrome, and Williams-Campbell syndrome (WKS) among others. 10 It is important to note that there have been several case reports of patients with MKS associated to Ehlers-Danlos syndrome, cystic fibrosis, Marfan's syndrome, and cutis laxa. 2,8 Among the acquired etiologies, posttraumatic, specially post tracheostomy stand out.…”

“…Large and central cystic bronchiectasis are commonly found, with bullae in the peripheric parenchyma. Using dynamic CT is an alternative to look for tracheobronchomalacia on expiratory scans, 8 , 9 defined as an airway collapse greater than 50% 10 that presents as a consequence of the tracheal anatomic alterations.…”

“…2,8 Among the acquired etiologies, posttraumatic, specially post tracheostomy stand out. Other causes are emphysema, asthma, chronic infections, and external compression of the trachea, 10 which can also be present in patients with MKS.…”

Physiotherapy for large airway collapse: an ABC approach

“…Some clinicians classify >50% reduction in luminal crosssectional area of the trachea on expiration as abnormal; however, this degree of collapse is often seen in asymptomatic healthy young individuals and thus >70% collapse on bronchoscopy or expiratory CT may be a more pragmatic diagnostic threshold [13]. Regardless, there is often an apparent disconnect between the degree of collapse seen and the symptomatic clinical burden which may be due to the contribution from co-existing conditions [14,15] (Figure 1). <Insert figure 1…”

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia

“…[1][2][3] Pathologically, severe TBM leads to atrophy of the posterior airway membrane and complete or nearcomplete collapse of the anterior tracheobronchial cartilage wall, ultimately attenuating dynamic airflow. 4 As a result, patients exhibit dyspnea, persistent cough, and are often predisposed to pneumonia and other respiratory infections. 5 Refractory and intractable symptoms may prompt further investigation with dynamic imaging and bronchoscopy leading to a diagnosis of TBM.…”