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Corcoran A, Foran A, Phinizy P, Biko DM, Piccione JC, Rapp JB. Dynamic airway computed tomography and flexible bronchoscopy for diagnosis of tracheomalacia in children: A comparison study. Pediatr Pulmonol 2024. [PMID: 38197524 DOI: 10.1002/ppul.26844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Tracheomalacia (TM) is an important cause of respiratory morbidity. Dynamic flexible bronchoscopy is considered the gold standard for diagnosis. Dynamic airway computed tomography (DACT) is a low radiation, noninvasive diagnostic tool utilizing images obtained continuously over several respiratory cycles. We aimed to assess the accuracy of DACT in TM diagnosis. METHODS Retrospective analysis of all patients who underwent both DACT and flexible bronchoscopy within 6 months. Airway anterior-posterior (AP) diameter was measured on multiplanar reconstructions CT in both the inspiratory and expiratory phases. Using still images from the bronchoscopy videos, the AP diameter of the trachea was measured at points of maximal and minimal diameter during tidal breathing. Degree of TM on both DACT and flexible bronchoscopy were graded using a scaling system of 50%-74%, 75%-89%, and 90%-100% as described by the European Respiratory Society. RESULTS Twenty-four patients met inclusion criteria with an average time of 19.5 days between CT and bronchoscopy. The specificity and sensitivity of DACT for the overall diagnosis of TM was 100% and 68%, respectively, with a positive predictive value of 100% and a negative predictive value of 62%. There was a strong positive correlation between DACT and flexible bronchoscopy in the measurement of tracheal AP diameter changes (ρ = 0.773, R2 0.597, p = 0.00001). Mean effective radiation dose for DACT was 0.1 mSv. CONCLUSION Ultralow dose DACT has excellent specificity and positive predictive value for both detection of TM and categorizing severity of tracheal collapse but is not sufficiently sensitive to rule it out.
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Affiliation(s)
- Aoife Corcoran
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ann Foran
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pelton Phinizy
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph C Piccione
- Department of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Espejo D, Zapata M, Omari S, Muñoz X, Cruz M. Acquired tracheomalacia due to SARS-CoV-2 pneumonia. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13719. [PMID: 38666787 PMCID: PMC10788234 DOI: 10.1111/crj.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Several studies mentioned parenchymal findings after SARS-CoV-2 pneumonia, but few studies have mentioned alterations in the airways. The aim of this study was to estimate the prevalence of tracheomalacia and to analyse the clinical characteristics in a cohort of patients with SARS-CoV-2. METHODS The study population consisted of all patients with SARS-CoV-2 admitted a hospital serving a population of 500 000 inhabitants. Patients were visited between 2 and 6 months after hospital discharge. In this visit, all patients were subjected to an exhaustive clinical questionnaire and underwent clinical examination, pulmonary function tests and chest CT. RESULTS From February 2020 to August 2021, 1920 patients were included in the cohort and tracheomalacia was observed in 15 (0.8%) on expiratory HRCT imaging. All patients with tracheomalacia also presented ground glass opacities in the CT scan and 12 patients had airway sequelae. CONCLUSIONS Tracheomalacia is an exceptional sequela of SARS-CoV-2 survivors.
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Affiliation(s)
- David Espejo
- Pulmonology Service, Department of Medicine, Vall d'Hebron University HospitalAutonomous University of BarcelonaBarcelonaSpain
| | - Marta Zapata
- Pulmonology Service, Department of Medicine, Vall d'Hebron University HospitalAutonomous University of BarcelonaBarcelonaSpain
| | - Saliha Omari
- Pulmonology Service, Department of Medicine, Vall d'Hebron University HospitalAutonomous University of BarcelonaBarcelonaSpain
| | - Xavier Muñoz
- Pulmonology Service, Department of Medicine, Vall d'Hebron University HospitalAutonomous University of BarcelonaBarcelonaSpain
- CIBER of Respiratory Diseases (CIBERES)BarcelonaSpain
- Department of Cell Biology, Physiology and ImmunologyAutonomous University of BarcelonaBarcelonaSpain
| | - Maria‐Jesús Cruz
- Pulmonology Service, Department of Medicine, Vall d'Hebron University HospitalAutonomous University of BarcelonaBarcelonaSpain
- CIBER of Respiratory Diseases (CIBERES)BarcelonaSpain
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Summary for Clinicians: Clinical Practice Guidelines for Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease. Ann Am Thorac Soc 2022; 19:873-879. [PMID: 35239469 DOI: 10.1513/annalsats.202201-007cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Higano NS, Bates AJ, Gunatilaka CC, Hysinger EB, Critser PJ, Hirsch R, Woods JC, Fleck RJ. Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value. Pediatr Radiol 2022; 52:643-660. [PMID: 35122130 PMCID: PMC8921108 DOI: 10.1007/s00247-021-05250-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 12/31/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.
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Affiliation(s)
- Nara S. Higano
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Alister J. Bates
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Chamindu C. Gunatilaka
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Erik B. Hysinger
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Paul J. Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Robert J. Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Radiology, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH 45229 USA
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5
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Cristea AI, Ren CL, Amin R, Eldredge LC, Levin JC, Majmudar PP, May AE, Rose RS, Tracy MC, Watters KF, Allen J, Austin ED, Cataletto ME, Collaco JM, Fleck RJ, Gelfand A, Hayes D, Jones MH, Kun SS, Mandell EW, McGrath-Morrow SA, Panitch HB, Popatia R, Rhein LM, Teper A, Woods JC, Iyer N, Baker CD. Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 204:e115-e133. [PMID: 34908518 PMCID: PMC8865713 DOI: 10.1164/rccm.202110-2269st] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Premature birth affects millions of neonates each year, placing them at risk for respiratory disease due to prematurity. Bronchopulmonary dysplasia is the most common chronic lung disease of infancy, but recent data suggest that even premature infants who do not meet the strict definition of bronchopulmonary dysplasia can develop adverse pulmonary outcomes later in life. This post-prematurity respiratory disease (PPRD) manifests as chronic respiratory symptoms, including cough, recurrent wheezing, exercise limitation, and reduced pulmonary function. This document provides an evidence-based clinical practice guideline on the outpatient management of infants, children, and adolescents with PPRD. Methods: A multidisciplinary panel of experts posed questions regarding the outpatient management of PPRD. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. Results: The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Recommendations were developed for or against three common medical therapies and four diagnostic evaluations in the context of the outpatient management of PPRD. Conclusions: The panel developed recommendations for the outpatient management of patients with PPRD on the basis of limited evidence and expert opinion. Important areas for future research were identified.
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Poore TS, Weinman JP, Handley E, Wine T, Helland S, Corbett B, Antoniolli N, Somme S, Friedlander J, Prager JD, DeBoer EM. Vascular and pulmonary comorbidities in children with congenital EA/TEF. Pediatr Pulmonol 2021; 56:571-577. [PMID: 33300304 DOI: 10.1002/ppul.25219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Esophageal atresia with tracheoesophageal fistula (EA/TEF) is associated with many congenital and vascular malformations; however, reports utilizing computed tomography (CT) and computed tomography angiography (CTA) are limited. The objective of this study is to review CT scans of the chest from patients with EA/TEF and report their pulmonary and vascular findings. METHODS We completed a retrospective chart review of children with congenital EA/TEF evaluated in the aerodigestive clinic at Children's Hospital Colorado. Results of the most recent CTA or CT of the chest were investigated. Demographics, medical conditions, and bronchoscopy findings were also recorded. The ratio of tracheal lumen area between inspiratory and expiratory CTA images was measured. RESULTS Of the patients with congenital EA/TEF seen in the program, 47 patients had a chest CT available for review. Eight patients (17%) had bronchiectasis. Of the contrast CT scans, 15 (58%) had a vascular abnormality and 16 (62%) demonstrated tracheal compression (38% at the level of the innominate artery, 35% from other structures). Nineteen of the CTAs had volumetric expiratory images of the trachea to evaluate tracheomalacia. The mean expiratory:inspiratory area was 0.57 (SD ± 0.23) at the level of the innominate. CONCLUSION Patients with EA/TEF frequently have vascular abnormalities that may alter airway mechanics as well as pulmonary comorbidities that may affect long-term management. For patients experiencing persistent respiratory symptoms, CTA of the chest should be considered adjunct to bronchoscopy to help with medical and surgical management of these children.
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Affiliation(s)
- Thomas S Poore
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jason P Weinman
- Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA.,Division of Pediatric Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elyse Handley
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Todd Wine
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sparrow Helland
- Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Benjamin Corbett
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Natalie Antoniolli
- Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Stig Somme
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Joel Friedlander
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Section of Gastroenterology, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jeremy D Prager
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emily M DeBoer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Section of Pulmonology and Sleep Medicine, The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
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7
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Prountzos S, Papakonstantinou O, Bizimi V, Velonakis G, Mazioti A, Douros K, Alexopoulou E. Large airway diseases in pediatrics: a pictorial essay. Acta Radiol Open 2021; 9:2058460120972694. [PMID: 33403124 PMCID: PMC7747119 DOI: 10.1177/2058460120972694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
“Large airway diseases” is being used as an all-encompassing phrase to describe a broad spectrum of pathological entities, which involves the trachea, main, lobar, and segmental bronchi of up to 3 mm diameter. Imaging modalities such as radiography, computed tomography, and magnetic resonance imaging contribute to the identification and diagnosis of each entity. Knowledge of clinical information, normal cross-sectional anatomy, and imaging characteristics of large airway diseases is necessary for appropriate radiologic evaluation. This review provides information about congenital and acquired diseases of the large airways in the pediatric population.
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Affiliation(s)
- Spyridon Prountzos
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Olympia Papakonstantinou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Vasiliki Bizimi
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Argyro Mazioti
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, "Attikon" University Hospital of Athens, Athens, Greece
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8
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Cellina M, Gibelli D, Floridi C, Cappella A, Oliva G, Dolci C, Giulia S, Sforza C. Changes of intrathoracic trachea with respiration in children: A metrical assessment based on 3D CT models. Clin Imaging 2021; 74:10-14. [PMID: 33421697 DOI: 10.1016/j.clinimag.2020.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
AIM To assess the tracheal volume and the effect of respiration through segmentation on CT-scans in children. MATERIAL AND METHODS Chest-CT of 100 patients divided into males and females, aged 3-16 years, were retrospectively assessed. Subjects underwent inspiratory and expiratory CT-scans. Tracheal volume was segmented through ITK-SNAP software. Volume, length, anteroposterior, laterolateral diameters, and T1-T10 distance were measured. The percentage ratio between expiratory and inspiratory phases was calculated: significant differences according to sex for inspiratory and expiratory measurements were assessed through a one-way ANCOVA test using T1-T10 distance as covariate (p < 0.05). Differences in percentage changes according to sex and age were assessed through Mann-Whitney test and calculation of Pearson's correlation coefficient, respectively (p < 0.05). RESULTS No statistically significant difference according to sex was found for any measurement (p > 0.05). For the percentage ratio between inspiratory and expiratory phase, no difference was found according to sex for any measurement (p > 0.05). The percentage ratio of tracheal volume and length between expiratory and inspiratory phases showed a negative correlation with age (p < 0.05). CONCLUSIONS This study provides a novel contribution to the assessment of tracheal size in healthy children: future studies will verify the same measurements in patients affected by tracheomalacia to improve diagnosis.
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Affiliation(s)
- Michaela Cellina
- Department of Radiology, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121 Milano, Italy
| | - Daniele Gibelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Chiara Floridi
- Department of Radiology, Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126 Ancona, AN, Italy
| | - Annalisa Cappella
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
| | - Giancarlo Oliva
- Department of Radiology, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121 Milano, Italy
| | - Claudia Dolci
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
| | - Signorelli Giulia
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
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Ramphul M, Bush A, Chang A, Prifits KN, Wallis C, Bhatt JM. The role of the pediatrician in caring for children with tracheobronchomalacia. Expert Rev Respir Med 2020; 14:679-689. [DOI: 10.1080/17476348.2020.1750374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Manisha Ramphul
- Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Andrew Bush
- Imperial College, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Anne Chang
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Children Centre for Health Research, Queensland University of Technology, Brisbane, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas N Prifits
- Allergy - Pulmonology Unit, 3rd Dept Paediatrics, Athens University Medical School, Chaidari, Greece
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children’s Hospital, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK
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10
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Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB, Charatsi AM, Coleman C, Depiazzi J, Douros K, Eber E, Everard M, Kantar A, Masters IB, Midulla F, Nenna R, Roebuck D, Snijders D, Priftis K. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54:13993003.00382-2019. [PMID: 31320455 DOI: 10.1183/13993003.00382-2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
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Affiliation(s)
- Colin Wallis
- Respiratory Medicine Unit, Great Ormond Street Hospital for Children, London, UK
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Universidad Complutense de Madrid, Madrid, Spain
| | - Jayesh M Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | | | - Julie Depiazzi
- Physiotherapy Dept, Perth Children's Hospital, Perth, Australia
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mark Everard
- Division of Paediatrics, University of Western Australia, Perth Children's Hospital, Perth, Australia
| | - Ahmed Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ian B Masters
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fabio Midulla
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Nenna
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Derek Roebuck
- Interventional Radiology Dept, Great Ormond Street Hospital, London, UK
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
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