Tracheal Web Research Articles

Manual jet ventilation to rescue a patient with pinhole tracheal stenosis: A case report

Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established.: Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.

Tracheal anomalies associated with Down syndrome: A systematic review.

IntroductionAirway anomalies are accountable for a substantial part of morbidity and mortality in children with Down syndrome (DS). Although tracheal anomalies occur more often in DS children, a structured overview on the topic is lacking. We systematically reviewed the characteristics of tracheal anomalies in DS children.MethodsA MEDLINE and EMBASE search for DS and tracheal anomalies was performed. Tracheal anomalies included tracheal stenosis, complete tracheal ring deformity (CTRD), tracheal bronchus, tracheomalacia, tracheal web, tracheal agenesis or atresia, laryngotracheoesophageal cleft type 3 or 4, trachea sleeve, and absent tracheal rings.ResultsFifty‐nine articles were included. The trachea of DS children is significantly smaller than non‐DS children. Tracheomalacia and tracheal bronchus are seen significantly more often in DS children. Furthermore, tracheal stenosis, CTRD, and tracheal compression by vascular structures are seen regularly in children with DS. These findings are reflected by the significantly higher frequency of tracheostomy and tracheoplasty performed in DS children.ConclusionIn children with DS, tracheal anomalies occur more frequently and tracheal surgery is performed more frequently than in non‐DS children. When complaints indicative of tracheal airway obstruction like biphasic stridor, dyspnea, or wheezing are present in children with DS, diagnostic rigid laryngotracheobronchoscopy with special attention to the trachea is indicated. Furthermore, imaging studies (computed tomography, magnetic resonance imaging, and ultrasound) play an important role in the workup of DS children with airway symptoms. Management depends on the type, number, and extent of tracheal anomalies. Surgical treatment seems to be the mainstay in severe cases.

Management of a Rare Case of Tracheal Web in a Resource Limited Sitting

Management of a Rare Case of Tracheal Web in a Resource Limited Sitting

Congenital Tracheal Web Inflammation Due to Pregnancy-Exacerbated Acid Reflux Presenting as a Severe Asthma Exacerbation

Congenital Tracheal Web Inflammation Due to Pregnancy-Exacerbated Acid Reflux Presenting as a Severe Asthma Exacerbation

A Tracheal Web as a Cause of Dyspnea in a Patient who had been treated for Asthma in the Past 35 years

A Tracheal Web as a Cause of Dyspnea in a Patient who had been treated for Asthma in the Past 35 years

Unsuspected Tracheal Web with Asthma-Like Symptom in a Young Female: Case Report

Background: Although most patients with asthma are easily controlled with appropriate medication, a small proportion of patients (approximately 5% of asthmatics) are difficult to control despite maximal inhaled therapy.Case Report: A 20-year-old girl admitted to the emergency ward (EW) of loghman hakim hospital in tehran with severe dyspnea. She was born with asphyxia for which oxygen therapy prescribed for two days. Conclusion: Congenital abnormality of the trachea can rarely present as asthma symptoms in adulthood. It is important to know, when encounter too difficult to treat asthma as the condition can be curable surgically.

頸部気管膜様部に気管嚢胞と気管ウェブを認めた 1 例

頸部気管膜様部に気管嚢胞と気管ウェブを認めた 1 例

CHAOS.

Congenital high airway obstruction syndrome (CHAOS) is a rare, usually lethal abnormality characterized by complete or near-complete intrinsic obstruction of the fetal airway. Laryngeal atresia is the most frequent cause, but other etiologies include laryngeal or tracheal webs, laryngeal cyst, subglottic stenosis or atresia, tracheal atresia and laryngeal or tracheal agenesis. When antenatal diagnosis of possible upper airway obstruction is made, specific type of obstruction is rarely determined making the term CHAOS introduced by Hedrick et al in 1994 more appropriate. Sonographic findings in CHAOS are characteristic and are secondary to high airway obstruction. The lungs are symmetrically enlarged, echogenic and homogenous. The distended lungs have mass effect on the diaphragm, which appears flattened or inverted, and the heart is displaced anteriorly in the midline. The heart often appears dwarfed by the surrounding enlarged lungs. The primary abnormality is an intrinsic obstruction of the upper airway. Normal lung development involves a continuous efflux of fluid from the fetal lungs. Laryngeal atresia/CHAOS stops the efflux of this fluid, and this retained fluid distends the alveoli with fluid giving the lungs voluminous echogenic appearance and inverting the diaphragm. Isolated airway obstruction without hydrops has a relatively favorable prognosis. CHAOS with associated anomalies and with early presentation of hydrops is an ominous sign with a high rate of fetal demise and a poor survival rate even with the ex utero intrapartum treatment (EXIT) procedure.

Shortness of breath caused by a tracheal web

Shortness of breath caused by a tracheal web

Shortness of breath caused by a tracheal web

Tracheal webs are rare anomalies that can be either congenital or acquired due to prolonged or traumatic endotracheal intubation. Patients with tracheal webs present with shortness of breath especially during exertion, stridor, and recurrent chest infections. They are often misdiagnosed and treated as bronchial asthma with only minimal relief of symptoms with bronchodilators. This condition can also present as a cause of difficult endotracheal intubations. CT scans of the chest can be used to screen for airway anomalies; bronchoscopy is both diagnostic and therapeutic. Here we present a 34-year-old woman with a tracheal web who had been on treatment for refractory asthma for many years with only partial relief of her symptoms.

Dexmedetomidine for Rigid Bronchoscopy in an Infant with Tracheal Web after Ventricular Septal Defect Patch Repair

We report herein successful rigid bronchoscopy with preserved spontaneous breathing of a 54-day-old infant with tracheal web associated with previous ventricular septal defect (VSD) repair. We considered the use of dexmedetomidine in conjunction with intermittent ketamine from the following three clinical aspects. First, this infant was suffering from respiratory distress with chest retraction, the cause of which was not revealed by a computerized scan of the neck and chest. Second, the patient was scheduled for rigid bronchoscopy, which is accompanied by brief but strong stimulation. Third, this infant underwent congenital VSD heart repair approximately 1 month earlier.

Reply

BACKGROUND In newborns with micrognathia and severe upper airway obstruction, understanding potential airway lesions is important for determining appropriate treatment: observation, mandibular distraction, or tracheostomy. When concomitant airway anomalies are present, mandibular distraction is often unsuccessful at alleviating causes of obstruction, mandating the need for tracheostomy. The first part of this study evaluates 10-year results using the University of California, Los Angeles, algorithm for surgical candidacy to identify patients who will benefit from neonatal mandibular distraction. The second part describes the concomitant airway abnormalities found at the time of diagnostic laryngoscopy/bronchoscopy and how these anomalies affect neonatal distraction candidacy of these patients. METHODS Newborns admitted to the neonatal intensive care unit with micrognathia and upper airway obstruction (n = 133) were subjected to a decision tree model protocol formulated by a multidisciplinary team at the University of California, Los Angeles, to decide on appropriate treatment. Concomitant airway abnormalities were recorded and outcomes were documented for the first 5 years of life. RESULTS Fifty-five percent of patients underwent internal mandibular distraction with 97 percent success. Home observation with a nasopharyngeal tube was chosen in 11 percent of patients, and 34 percent had tracheostomies. On endoscopic examination, 51.7 percent of the nondistracted patients had concomitant airway anomalies: laryngomalacia (53.3 percent), tracheal web (20.0 percent), vocal cord paralysis (13.3 percent), epiglottal collapse (6.7 percent), and infraglottal narrowing (6.7 percent). CONCLUSIONS For the management of neonatal upper airway obstruction with micrognathia, a decision tree algorithm is useful to determine candidates for mandibular distraction. Diagnostic laryngoscopy/bronchoscopy is an important component of this algorithm because a multitude of airway anomalies may be present. CLINICAL QUESTION/LEVEL OF EVIDENCE : Therapeutic, IV.

Incidence of Concomitant Airway Anomalies When Using the University of California, Los Angeles, Protocol for Neonatal Mandibular Distraction

In newborns with micrognathia and severe upper airway obstruction, understanding potential airway lesions is important for determining appropriate treatment: observation, mandibular distraction, or tracheostomy. When concomitant airway anomalies are present, mandibular distraction is often unsuccessful at alleviating causes of obstruction, mandating the need for tracheostomy. The first part of this study evaluates 10-year results using the University of California, Los Angeles, algorithm for surgical candidacy to identify patients who will benefit from neonatal mandibular distraction. The second part describes the concomitant airway abnormalities found at the time of diagnostic laryngoscopy/bronchoscopy and how these anomalies affect neonatal distraction candidacy of these patients. Newborns admitted to the neonatal intensive care unit with micrognathia and upper airway obstruction (n = 133) were subjected to a decision tree model protocol formulated by a multidisciplinary team at the University of California, Los Angeles, to decide on appropriate treatment. Concomitant airway abnormalities were recorded and outcomes were documented for the first 5 years of life. Fifty-five percent of patients underwent internal mandibular distraction with 97 percent success. Home observation with a nasopharyngeal tube was chosen in 11 percent of patients, and 34 percent had tracheostomies. On endoscopic examination, 51.7 percent of the nondistracted patients had concomitant airway anomalies: laryngomalacia (53.3 percent), tracheal web (20.0 percent), vocal cord paralysis (13.3 percent), epiglottal collapse (6.7 percent), and infraglottal narrowing (6.7 percent). For the management of neonatal upper airway obstruction with micrognathia, a decision tree algorithm is useful to determine candidates for mandibular distraction. Diagnostic laryngoscopy/bronchoscopy is an important component of this algorithm because a multitude of airway anomalies may be present. : Therapeutic, IV.

Unexpected difficult intubation owing to a tracheal web in a patient with past history of a Fontan procedure

Unexpected difficult intubation owing to a tracheal web in a patient with past history of a Fontan procedure

Tracheal web with slow progression

Postintubation tracheal web is a rare, but serious problem. The symptoms, which depend on the degree of the stenosis, may begin in a few months and increase with the rapid progression of the stenosis. In this article, we present a case of postintubation tracheal web which leading to late symptoms despite a 75% obstruction of the lumen with slow progression.

Successful double lumen tube insertion in a patient with unanticipated laryngeal and tracheal web

A 45-year-old female patient admitted for surgical management of carcinoma esophagus, presented with difficulty in insertion of left-sided 37 F and 35 F double lumen tube (Mallinckrodt® Broncho-Cath). Fiberoptic bronchoscopy revealed a subglottic web in the larynx just below the vocal cords and a tracheal web just above the carina. Differential lung ventilation could be achieved with a 35 F internal diameter double lumen tube (Portex® Blueline® Endobronchial tube).

Successful diagnosis and treatment of congenital tracheal web using a fiberoptic bronchoscope

Congenital tracheal web is a very rare abnormality that often manifests as wheezing, dyspnea, and respiratory failure. Misdiagnosis is common. Here we describe the case of a 47-day-old female infant who presented after severe, extended coughing. The diagnosis of congenital tracheal web was made following coronal computer tomography (CT) reconstruction and bronchoscopy. The bronchoscope was used to facilitate tracheal expansion. This is the youngest case reported to date to highlight the diagnosis and treatment of a 47 days infant with congenital tracheal web. An infant with tracheal web, a very rare congenital anomaly can be clearly diagnosed by coronal CT reconstruction combined with bronchoscopy. If diagnosed early, the bronchoscope may be used to facilitate tracheal expansion.

Unsuspected tracheal web inhibits endotracheal intubation: report of a case

A 66-year-old woman was scheduled for resection of a recurrent brain astrocytoma. During anesthesia induction, endotracheal intubation became impossible. Urgent bronchoscopy under laryngeal mask ventilation visualized a subglottic web 1 cm below the vocal cords. After bronchoscopic ablation with argon plasma coagulation, the airway intubation was successful.

An unusual case of wheeze

We report the case of a 12-year-old girl who was managed as an asthma patient since infancy but was later found to have a tracheal web. Born at 31 weeks...

Tracheal Web

Postintubation tracheal web is a rarely encountered complication of endotracheal intubation. Although few of them remain asymptomatic until diagnosed accidentally, most of them present with symptoms of acute airway obstruction and even death. We present here a case of postintubation tracheal web with uncommon features, including a very long delay in diagnosis despite a 99% obstruction of the tracheal lumen.