Helical CT scan to diagnose tracheomalacia in children

Abstract

Background/Aims: Tracheomalacia (TM) is a rather usual paediatric clinical condition but difficult to confirm. The aim of our study was to assess the accuracy of expiratory helical CT scan (HCT) in detecting TM. Methods: We performed flexible bronchoscopy (FB) in 21 school-age children suspected of TM on the grounds of clinical symptoms, namely vibrating cough (defined as biphasic bouts commencing with dry and climaxing with an intense brassy cough accompanied with a sense of vibration in chest wall cough). Many children had also classic barking cough with stridor and/or recurrent chest infections. Children diagnosed with FB as having TM were further investigated with helical computed tomography scan (HCT).The cross-sectional area ratio of the trachea at the level of maximum end-expiration collapse during end-expiration and end-inspiration (CSR), determined the basis for the HCT diagnosis as well as calculation of the degree of TM. Four children who underwent HCT for reasons unrelated with TM, served as controls. Results: FB confirmed the presence of TM in 19/21 (89%) patients. Mean (95% C.I.) CSR was 0.59 (0.54-0.65) and 0.89 (0.78-0.98), in patients and controls, respectively (p 0.7. Conclusion: HCT can effectively diagnose TM in the majority of children. However, although the criterion of CSR ≤0.5 is well established in adults, it is not suitable in children since it underdiagnoses malacia. This is, at least partially, due to the poorly performed forced expiratory manoeuvre from children. CSR ≤0.7 would be a more appropriate threshold for children.