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Pfeifer M, Rehder H, Gerykova Bujalkova M, Bartsch C, Fritz B, Knopp C, Beckers B, Dohle F, Meyer-Wittkopf M, Axt-Fliedner R, Beribisky AV, Hofer M, Laccone F, Schoner K. Tracheal agenesis versus tracheal atresia: anatomical conditions, pathomechanisms and causes with a possible link to a novel MAPK11 variant in one case. Orphanet J Rare Dis 2024; 19:114. [PMID: 38475835 DOI: 10.1186/s13023-024-03106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND In this study we aimed to describe the morphological and pathogenetic differences between tracheal agenesis and tracheal atresia, which are not clearly distinguished from each other in the literature, and to contribute thereby to the understanding and management of these conditions. Both tracheal agenesis and tracheal atresia represent rare disorders of still unknown aetiology that cannot be detected by prenatal ultrasound. If the affected foetuses survive until birth these conditions result in respiratory failure and in futile attempts to rescue the infant's life. RESULTS Autopsies and genetic analyses, including singleton or trio exome sequencing, were performed on five neonates/foetuses with tracheal agenesis and three foetuses with tracheal atresia. Tracheal agenesis was characterized by absence of the sublaryngeal trachea and presence of a bronchooesophageal fistula and by pulmonary isomerism and occurred as an isolated malformation complex or as part of a VACTERL association. Special findings were an additional so-called 'pig bronchus' and a first case of tracheal agenesis with sirenomelia. Tracheal atresia presenting with partial obliteration of its lumen and persistence of a fibromuscular streak resulted in CHAOS. This condition was associated with normal lung lobulation and single, non-VACTERL type malformations. Trio ES revealed a novel variant of MAPK11 in one tracheal agenesis case. Its involvement in tracheooesophageal malformation is herein discussed, but remains hypothetical. CONCLUSION Tracheal agenesis and tracheal atresia represent different disease entities in terms of morphology, pathogenesis and accompanying anomalies due to a primary developmental and secondary disruptive possibly vascular disturbance, respectively.
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Affiliation(s)
- Mateja Pfeifer
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Helga Rehder
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria.
- Institute of Pathology, Fetal Pathology, Philipps-University of Marburg, Marburg, Germany.
| | - Maria Gerykova Bujalkova
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Christine Bartsch
- Institute of Forensic Medicine, University of Zürich, Zurich, Switzerland
- Berlin School of Economics and Law (HWR), Berlin, Germany
| | - Barbara Fritz
- Institute of Human Genetics, Philipps-University of Marburg, Marburg, Germany
| | | | | | - Frank Dohle
- Department of Pediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | | | - Roland Axt-Fliedner
- Division of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, Giessen, Germany
| | - Alexander V Beribisky
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Manuel Hofer
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Katharina Schoner
- Institute of Pathology, Fetal Pathology, Philipps-University of Marburg, Marburg, Germany
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Heriseanu C, Bizubac M, Draghia L, Marcu V, Gheorghe D, Cirstoveanu C. Congenital High Airway Obstructive Syndrome (CHAOS) Survival of a Newborn with Laryngeal Atresia. Diagnostics (Basel) 2023; 13:3658. [PMID: 38132244 PMCID: PMC10742956 DOI: 10.3390/diagnostics13243658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Congenital high airway obstructive syndrome (CHAOS) is a rare congenital anomaly, frequently caused by laryngeal or tracheal atresia, tracheal stenosis, and obstructing laryngeal cysts. This is a congenital malformation, often fatal, with an unknown prevalence. Laryngeal atresia is the most frequent cause. We report a case of an intrauterine diagnosis of CHAOS and ascites in a 17-week fetus delivered at 38 weeks of gestation without other associated malformations. A fetoscopic procedure was performed at 22 weeks of gestation. An attempt was made to perforate the affected area to ensure pulmonary fluid circulation and the ascites' resolution. After birth, a tracheostomy was performed. The patient was mechanically ventilated until 11 months of age, when she was discharged with no cerebral or other complications of immediate postnatal anoxia or episodes of respiratory arrest. A laryngotracheoplasty was performed at 2 years old, but decannulation was not possible due to certain complications. At 5 years old, a new surgical intervention was performed, which allowed decannulation 6 months later.
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Affiliation(s)
- Carmen Heriseanu
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Bizubac
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Loredana Draghia
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
| | - Veronica Marcu
- Department of Radiology, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania;
| | - Dan Gheorghe
- Department of ENT, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Catalin Cirstoveanu
- Neonatal Intensive Care Unit, “M.S. Curie” Children’s Hospital, Constantin Brâncoveanu Boulevard, No. 20, 4th District, 041451 Bucharest, Romania; (C.H.); (L.D.); (C.C.)
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Hirotani T, Tamura R, Ando M, Okajima H. External Esophageal Stenting Technique in Palliation for Tracheal Agenesis in a Case of Esophageal Lung: A Lesson Learned from the Experience for Tracheomalacia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1907. [PMID: 38136109 PMCID: PMC10741666 DOI: 10.3390/children10121907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Tracheal agenesis (TA) is a rare congenital anomaly with an incidence of 1 per 50,000 newborns. It appears at birth with severe respiratory distress, cyanosis, and inaudible crying. Prompt esophageal intubation and long-term management of the esophageal airway are essential to overcome this catastrophic condition. In the long-term management, external stenting of the esophageal airway has been reported as promising to support the fragile esophageal wall; this technique was taken from the surgery for tracheomalacia. We experienced a case of an infant with tracheal agenesis whose respiratory status was stabilized after external esophageal stenting. The stenting was performed based on a lesson learned in the extensive experience in the surgical treatment for tracheomalacia, and the surgical techniques for successful stenting are herein described.
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Affiliation(s)
- Taichi Hirotani
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Ryo Tamura
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Makoto Ando
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
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Hino Y, Hayashida M, Kitadai Y, Kan N, Tsukimori K. A case of tracheal agenesis: Prenatal imaging resembles esophageal atresia. Pediatr Int 2022; 64:e14753. [PMID: 34761853 DOI: 10.1111/ped.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yuko Hino
- Department of Pediatric Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Makoto Hayashida
- Department of Pediatric Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuzo Kitadai
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuhiko Kan
- Department of Neonatal Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kiyomi Tsukimori
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka, Japan
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Yamamoto T, Kurabe M, Matsumoto K, Sugai S, Baba H. Congenital Tracheal Aplasia Without Prenatal Diagnosis Masked by Maternal Obesity and Gestational Diabetes: A Case Report. A A Pract 2021; 14:e01200. [PMID: 32784317 DOI: 10.1213/xaa.0000000000001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This case report describes a neonate with tracheal aplasia first diagnosed after birth due to the presentation of respiratory distress, absence of crying, and unsuccessful tracheal intubation. The most common finding with tracheal aplasia is polyhydramnios. However, diagnosis remains challenging in the prenatal period. In this case, maternal obesity and gestational diabetes made diagnosis more difficult. The only lifesaving treatment available is ventilation through esophageal intubation or tracheostomy. However, in some cases, tracheostomy is not an option.
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Affiliation(s)
| | | | - Kensuke Matsumoto
- Division of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shunya Sugai
- Division of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Iinuma Y, Uchiyama M, Okuyama N, Murata H, Kuwabara S, Hirayama Y, Komatsuzaki N, Nakaya K, Sugai Y, Taki S, Nitta K. The long-term outcome of tracheal agenesis following reconstruction of the airway and alimentary tract. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bresciani L, Grazioli P, Bosio R, Chirico G, Zambelloni C, Santoro A, Baronchelli C, Redaelli de Zinis LO. Neonatal Respiratory Distress and Airway Emergency: Report of Two Cases. CHILDREN-BASEL 2021; 8:children8040255. [PMID: 33805876 PMCID: PMC8064368 DOI: 10.3390/children8040255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022]
Abstract
We discuss two cases of congenital airway malformations seen in our neonatal intensive care unit (NICU). The aim is to report extremely rare events characterized by immediate respiratory distress after delivery and the impossibility to ventilate and intubate the airway. The first case is a male twin born at 34 weeks by emergency caesarean section. Immediately after delivery, the newborn was cyanotic and showed severe respiratory distress. Bag-valve-mask ventilation did not relieve the respiratory distress but allowed for temporary oxygenation during subsequent unsuccessful oral-tracheal intubation (OTI) attempts. Flexible laryngoscopy revealed complete subglottic obstruction. Postmortem analysis revealed a poly-malformative syndrome, unilateral multicystic renal dysplasia with a complete subglottic diaphragm, and a tracheo-esophageal fistula (TEF). The second case is a male patient that was vaginally born at 35 weeks. Antenatally, an ultrasound (US) arose suspicion for a VACTERL association (vertebral defects, anal atresia, TEF with esophageal atresia and radial or renal dysplasia, plus cardiovascular and limb defects) and a TEF, and thus, fetal magnetic resonance (MRI) was scheduled. Spontaneous labor started shortly thereafter, before imaging could be performed. Respiratory distress, cyanosis, and absence of an audible cry was observed immediately at delivery. Attempts at OTI were unsuccessful, whereas bag-valve-mask ventilation and esophageal intubation allowed for sufficient oxygenation. An emergency tracheostomy was attempted, although no trachea could be found on cervical exploration. Postmortem analysis revealed tracheal agenesis (TA), renal dysplasia, anal atresia, and a single umbilical artery. Clinicians need to be aware of congenital airway malformations and subsequent difficulties upon endotracheal intubation and must plan for multidisciplinary management of the airway at delivery, including emergency esophageal intubation and tracheostomy.
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Affiliation(s)
- Lorenzo Bresciani
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (L.B.); (P.G.); (R.B.)
| | - Paola Grazioli
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (L.B.); (P.G.); (R.B.)
| | - Roberta Bosio
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (L.B.); (P.G.); (R.B.)
| | - Gaetano Chirico
- Department of Neonatology and Neonatal Intensive Care Unit, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (G.C.); (C.Z.)
| | - Cesare Zambelloni
- Department of Neonatology and Neonatal Intensive Care Unit, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (G.C.); (C.Z.)
| | - Amerigo Santoro
- Department of Pathology, University of Brescia, 25123 Brescia, Italy; (A.S.); (C.B.)
| | - Carla Baronchelli
- Department of Pathology, University of Brescia, 25123 Brescia, Italy; (A.S.); (C.B.)
| | - Luca O. Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital “ASST Spedali Civili”, 25123 Brescia, Italy; (L.B.); (P.G.); (R.B.)
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Audiology, University of Brescia, 25123 Brescia, Italy
- Correspondence: ; Tel.: +39-030-399-6236
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Nimeri N, Ali H, Mahmoud N. Lethal severe congenital tracheal stenosis with tracheal ring complicating respiratory distress syndrome in an extremely premature infant: first reported case in Qatar with a literature review. BMJ Case Rep 2020; 13:13/12/e236107. [PMID: 33310828 PMCID: PMC7735117 DOI: 10.1136/bcr-2020-236107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In the context of prematurity, lethal congenital airways malforamtion can be masked by the symptoms of respiratory distress syndrome. A high index of suspicion is required. We present the case of a 28-week preterm infant, with atypical protracted respiratory insufficiency despite the escalation of mechanical ventilation. The possibility of airway obstruction was considered in view of severe chest retraction while on the mechanical ventilator. It was also difficult to pass suction catheters beyond a certain depth in the trachea; however, intubation of the upper trachea was accomplished twice without difficulty. Flexible bronchoscopy revealed complete tracheal ring with severe tracheal stenosis; there was no evidence of tracheo-oesophageal fistula. Due to advanced multi-organ dysfunction at diagnosis, a decision was made with the family to re-orientate from intensive care to compassionate care. Ethical considerations in similar cases should incorporate the improved outcomes of prematurity and recent advances in tracheal reconstruction.
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Affiliation(s)
- Nuha Nimeri
- Department of Paediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Haytham Ali
- Department of Pediatric, Sidra Medical and Research Center, Doha, Qatar
| | - Nazla Mahmoud
- Department of Paediatrics, Hamad Medical Corporation, Doha, Qatar
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Qi Y, Huo H, Ma M, Wu J, Li X, Liu B. Prenatal diagnosis of pulmonary artery sling associated with tracheal agenesis: A case report. Echocardiography 2020; 37:2148-2151. [PMID: 33145790 DOI: 10.1111/echo.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery sling (PAS) and tracheal agenesis (TA) are rare diseases, and most cases of PAS are associated with tracheal bronchial malformations. However, PAS associated with TA is yet to be reported. We report a case of PAS with TA diagnosed prenatally. Due to the extremely low incidence, physicians do not have sufficient understanding of these diseases and it is challenging to diagnose these diseases by prenatal ultrasound, with high rates of misdiagnosis. Prenatal examination of the pulmonary artery branches, trachea, and esophagus is useful; therefore, improving the accuracy of prenatal diagnosis will help in perinatal management and counseling.
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Affiliation(s)
- Yanhua Qi
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanhuan Huo
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miaoyan Ma
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinfang Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopeng Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baomin Liu
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Tracheal agenesis: A rare cause of inability to secure the airways in a newborn. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Straughan AJ, Mulcahy CF, Sandler AD, Bauman NM, Steinhorn D, Gitman L. Tracheal Agenesis: Vertical Division of the Native Esophagus - A Novel Surgical Approach and Review of the Literature. Ann Otol Rhinol Laryngol 2020; 130:547-562. [PMID: 33030043 DOI: 10.1177/0003489420962124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. METHODS Case report and literature review. RESULTS A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. CONCLUSION We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.
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Affiliation(s)
- Alexander J Straughan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | - Lyuba Gitman
- Children's National Health System, Washington, DC, USA
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Perri A, Patti ML, Sbordone A, Vento G, Luciano R. Unexpected tracheal agenesis with prenatal diagnosis of aortic coarctation, lung hyperecogenicity and polyhydramnios: a case report. Ital J Pediatr 2020; 46:96. [PMID: 32650808 PMCID: PMC7353673 DOI: 10.1186/s13052-020-00861-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/01/2020] [Indexed: 12/03/2022] Open
Abstract
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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Affiliation(s)
- Alessandro Perri
- Department of Woman and Child Health and Public Health, Child Health Area; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Maria Letizia Patti
- Department of Woman and Child Health and Public Health, Child Health Area, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Annamaria Sbordone
- Department of Woman and Child Health and Public Health, Child Health Area, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Child Health Area, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rita Luciano
- Department of Woman and Child Health and Public Health, Child Health Area; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
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14
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Saadi S, Ben Abdeljelil N, Ben Salem A, Chioukh FZ, Haj Salem N. Tracheal agenesis clinical presentation in a preterm infant: Prenatal MRI difficulties and autopsy findings. Radiol Case Rep 2020; 15:1604-1608. [PMID: 32685079 PMCID: PMC7355954 DOI: 10.1016/j.radcr.2020.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Said Saadi
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Forensic Medicine, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Pathology, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
| | - Amina Ben Salem
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Medical Imaging B, Maternity and Neonatal Teaching Center, 5000, Monastir, Tunisia
| | - Fatma Zohra Chioukh
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Intensive Care and Neonatal Medicine, Maternity and Neonatal Teaching Center, 5000, Monastir, Tunisia
| | - Nidhal Haj Salem
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Forensic Medicine, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
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15
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Lupariello F, Di Vella G, Botta G. Death Shortly after Delivery Caused by Congenital High Airway Obstruction Syndrome. Fetal Pediatr Pathol 2020; 39:179-183. [PMID: 31342827 DOI: 10.1080/15513815.2019.1644688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Congenital High Airway Obstruction Syndrome (CHAOS) is an uncommon anomaly. Prenatal ultrasonography allows a prenatal diagnosis to prepare for immediate surgical correction at birth. If the obstruction is severe and a correct therapeutic approach is not planned, CHAOS can cause neonatal death shortly after delivery from a potentially surgically correctable lesion.Case report: This neonate died unexpectedly shortly after delivery due to CHAOS. Ultrasonographic findings of enlarged echogenic lungs, dilated airways distal to the obstruction, flattened or inverted diaphragms, or ascites were absent. This was due to a type-II laryngeal-atresia and a type-C esophageal-atresia, with a resultant distal fistula that allowed intrauterine decompression of the fluid in the lungs.Conclusions: The absence of prenatal ultrasonographic findings of CHAOS may be due to a lower fistula between respiratory and gastrointestinal tracts. This set of associations may not be a surgically correctable cause of CHAOS.
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16
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Krishnamurthy K, Kochiyil J, Poppiti RJ. Tracheal agenesis with esophageal atresia: an autopsy case report of a variant incompatible with life. Fetal Pediatr Pathol 2020; 39:45-50. [PMID: 31314628 DOI: 10.1080/15513815.2019.1627628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Tracheal agenesis/atresia (TA) presents with respiratory distress at birth and subsequent difficulty in endotracheal intubation. The antenatal course is complicated by polyhydramnios and premature labor. Case report: We present a newborn baby boy with respiratory distress and unsuccessful intubation. Postmortem neck dissection revealed tracheal atresia with esophageal atresia and high tracheoesophageal fistula. Conclusion: In this variant of tracheal atresia, the coexistent esophageal atresia precluded the establishment of a functional air passage. This variant that does not fall into the any of the described categories in accepted classification systems. The lack of any distal communication makes this case inoperable and fatal.
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Affiliation(s)
- Kritika Krishnamurthy
- Arkadi M. Rywlin M.D., Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Robert J Poppiti
- Arkadi M. Rywlin M.D., Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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17
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Cuppari C, Cutrupi MC, Salpietro A, Sallemi A, Fusco M, Parisi GF, Salpietro C. Genetic Anomalies of the Respiratory Tract. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666191022100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hereditary lung diseases can affect the airways, parenchyma and vasculature of the lung.
Such diseases comprehend simple monogenic disorders such as Kartagener syndrome and
α1-antitrypsin deficiency, in which mutations of critical genes are sufficient to induce well‐defined
disease phenotypes. A major comprehension of the genetic basis of pulmonary diseases has produced
new investigations into their underlying pathophysiology and contributed sometimes to clarify on
more frequent sporadic forms. The presence of these structural abnormalities of the respiratory tract
can be fatal, so that the identification of causative genes has allowed prenatal diagnosis for many
diseases giving a greater hope of survival thanks to a more adequate and prompt management.
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Affiliation(s)
- Caterina Cuppari
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Maria Concetta Cutrupi
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | | | - Alessia Sallemi
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Monica Fusco
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
| | - Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carmelo Salpietro
- Department of Human Pathology of the Adult and Developmental Age “Gaetano Barresi”, Unit of Pediatric Emergency, University of Messina, Messina, Italy
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18
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Congenital Segmental Absence of Tracheal Rings in a Kitten. J Comp Pathol 2019; 172:58-61. [PMID: 31690417 DOI: 10.1016/j.jcpa.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 11/21/2022]
Abstract
Congenital anomalies of the trachea are rare in cats. This article reports segmental absence of tracheal cartilage rings in a kitten. An 8-month-old female kitten was presented with a history of weight loss and respiratory distress for 2 months. Radiographs of the thorax demonstrated a large air-filled sac suggestive of pneumomediastinum. No cartilaginous structures were evident radiographically over the caudal portion of the trachea. At necropsy examination, approximately 2 cm from the carina, a 3 cm segment of the trachea lacked cartilaginous rings. The clinical and morphological features of this lesion were similar to those described in human and canine cases of congenital segmental absence of tracheal rings.
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19
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Causes of death shortly after delivery and medical malpractice claims in congenital high airway obstruction syndrome: Review of the literature. Leg Med (Tokyo) 2019; 40:61-65. [PMID: 31442942 DOI: 10.1016/j.legalmed.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/07/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
Abstract
Congenital High Airway Obstruction Syndrome is a rare pathology that may conduct the baby to death shortly after delivery. This outcome may cause emotional distress in the parents but it may also generate expensive medical malpractice claims about the reasons why the syndrome was not identified and/or correctly treated. The authors conducted a review of the cases in which Congenital High Airway Obstruction Syndrome caused death of the baby shortly after delivery. Then, they pointed out these ultrasonographic and anatomical reasons why the syndrome may be not identified and/or correctly treated: negative prenatal ultrasonography, recurrence of non-specific findings at prenatal ultrasonography, connection of respiratory and gastrointestinal tracts, tracheal agenesis or atresia, parent's refuse of post-partum therapeutic procedures, multiple malformations of the fetus/child. In conclusion, the authors highlighted that death shortly after delivery is usually caused by specific conditions that are not influenced by healthcare team's practice.
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20
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Densmore JC, Oldham KT, Dominguez KM, Berdan ER, McCormick ME, Beste DJ, Amos LB, Lang CA, Woods RK, Kouretas PC, Mitchell ME. Neonatal esophageal trachealization and esophagocarinoplasty in the treatment of flow-limited Floyd II tracheal agenesis. J Thorac Cardiovasc Surg 2019; 153:e121-e125. [PMID: 28526113 DOI: 10.1016/j.jtcvs.2017.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
- John C Densmore
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis.
| | - Keith T Oldham
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis
| | | | - Elizabeth R Berdan
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E McCormick
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - David J Beste
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - Louella B Amos
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Cecilia A Lang
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Ronald K Woods
- Children's Research Institute, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Peter C Kouretas
- Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
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21
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Abstract
RATIONALE Tracheal atresia (TA) involves complete or partial tracheal absence below the larynx. It involves failure of complete separation of the laryngotracheal diverticulum from the foregut at the 4th gestational week. In TA, the trachea and main bronchi generally proceed in the normal caudal directions. PATIENT CONCERNS At the gestational age of 34 weeks and 6 days, a male baby weighing 2290 g was born via cesarean section. A brisk bag was used, and mask ventilation was performed, but was not effective. Intubation was attempted; however, the endotracheal tube did not advance below the vocal cord. DIAGNOSIS Tracheal atresia. INTERVENTIONS An emergent open neck exploration could not reveal the trachea. On computed tomography, the tracheoesophageal fistula (TEF) started from the lower esophagus just above the gastroesophageal junction. The trachea arose upward to form the main bronchus. OUTCOMES His parents signed the "Do not resuscitate" form due to poor outcome. On the 23rd day of birth, the baby expired. LESSONS Our case involved TA with tracheoesophageal fistula forming between the trachea and main bronchi in a cephalic direction as detected on computed tomography. Further, the trachea arose from the gastroesophageal junction; thus, it does not belong to any Floyd classification. Herein, we report a TA case with a cephalically developed lung bud.
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22
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Korkmaz L, Güneş I, Halis H, Ketenci İ, Baştuğ O, Doğan MS, Akın MA. A case of laryngeal atresia accompanied by persistent pharyngotracheal ductus. Turk Arch Pediatr 2019; 54:57-60. [PMID: 31217712 PMCID: PMC6559978 DOI: 10.5152/turkpediatriars.2018.4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/13/2017] [Indexed: 11/22/2022]
Abstract
Laryngeal atresia is generally a fatal congenital anomaly with an incidence of 1: 50,000 births. This congenital anomaly is a condition of multifactorial inheritance, in which the fetus has a dilated trachea, enlarged echogenic lungs, an inverted or flattened diaphragm, fetal hydrops, and ascites. Diagnosis is usually made when there is failure to perform endotracheal intubation in a neonate with severe respiratory distress and absence of audible cry. Here, we present a very rare case of a newborn with laryngeal atresia who had respiratory distress and was sustained for the first few minutes of life using partial ventilation via a persistent pharyngotracheal duct. We would like to draw the attention of all physicians to this issue by reporting a rare fatal case of a newborn with a congenital presentation.
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Affiliation(s)
- Levent Korkmaz
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Işın Güneş
- Department of Anesthesiology and Reanimation, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Hülya Halis
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - İbrahim Ketenci
- Department of Otolaryngology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Osman Baştuğ
- Division of Neonatology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Said Doğan
- Department of Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Ali Akın
- Neonatology Unit, Department of Pediatrics Kayseri Training and Research Hospital, Kayseri, Turkey
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23
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Naina P, John M, Kathar MA, Kumar M. Tracheal agenesis in a new born: lessons learnt. BMJ Case Rep 2018. [PMID: 29914900 DOI: 10.1136/bcr-2017-224003.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mohamed Abdul Kathar
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
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24
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Naina P, John M, Kathar MA, Kumar M. Tracheal agenesis in a new born: lessons learnt. BMJ Case Rep 2018; 2018:bcr-2017-224003. [PMID: 29914900 DOI: 10.1136/bcr-2017-224003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mohamed Abdul Kathar
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
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25
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Tracheal agenesis: optimization of computed tomography diagnosis by airway ventilation. Pediatr Radiol 2018; 48:427-432. [PMID: 29147912 DOI: 10.1007/s00247-017-4024-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
Tracheal agenesis is a rare and often lethal congenital defect that leads to airway emergency at birth. Computed tomography (CT) is the modality of choice to evaluate anomalous tracheal anatomy. The absence of spontaneous aeration of the tracheobronchial tree in children with tracheal agenesis makes CT interpretation difficult. We describe a procedure of airway management applied in two newborns with suspected tracheal agenesis. Correct airway management was performed immediately prior to CT examination by airway ventilation, with bag-valve mask alone in one case, and attached to an endotracheal tube placed into the esophagus in the other case. The images allowed for classification of tracheal agenesis. Computed tomography with appropriate airway ventilation is fundamental for the diagnosis of tracheal agenesis.
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26
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Sattler C, Chiao F, Stein D, Murphy D. Life-Saving Esophageal Intubation in Neonate With Undiagnosed Tracheal Agenesis: A Case Report. ACTA ACUST UNITED AC 2017; 9:31-34. [PMID: 28410262 DOI: 10.1213/xaa.0000000000000518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 3-day-old, 2.2-kg former 34-week premature infant with imperforate anus required loop ileostomy surgery. At delivery, the child had respiratory distress. Endotracheal intubation was "confirmed" by detection of exhaled carbon dioxide with a Pedi-Cap (Covidien, Dublin, Ireland) and subsequent chest x-ray. On arrival to the operating room, the pulse oximeter reading was 100% despite a large leak around the endotracheal tube and high-airway pressures. Packing the throat reduced the leak and increased the tidal volume. Intraoperative bronchospasm occurred during the surgery. On postoperative day 1, fiberoptic examination by an otolaryngologist revealed esophageal intubation and the absence of laryngeal opening. Subsequent computed tomography scan revealed Floyd type II tracheal agenesis. To our knowledge, this is the only case of tracheal agenesis diagnosed after a non-airway related procedure. We discussed how the diagnosis was missed.
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Affiliation(s)
- Christopher Sattler
- From the Department of Anesthesiology, NewYork Presbyterian Hospital-Weill Cornell Medical College, New York, New York
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27
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Jamieson K, Boyd S, Tan S, Wong D, James P, Durward A, Nyman A. Case-based discussion from the neonatal intensive care unit: a case of an intentional oesophageal intubation. Thorax 2017; 73:thoraxjnl-2017-210717. [PMID: 29222094 DOI: 10.1136/thoraxjnl-2017-210717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/04/2022]
Abstract
Tracheal agenesis (TA) is a rare congenital defect consisting of complete or partial absence of the trachea below the larynx. Antenatal diagnosis is challenging, and most cases are detected in the postnatal period. Airway management of such cases, particularly in the absence of antenatal diagnosis, can be challenging. Various methods of management have been described but with limited success, and overall prognosis remains very poor. We present an unexpected case of TA, highlighting management issues and diagnostic methods.
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Affiliation(s)
- Katharine Jamieson
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephanie Boyd
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susern Tan
- Neonatal Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Davina Wong
- Department of Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul James
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Durward
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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28
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Atkins MD, Fuller S. Thoracic Surgery Considerations in the Child and Young Adult. Thorac Surg Clin 2017; 28:43-52. [PMID: 29150036 DOI: 10.1016/j.thorsurg.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vascular rings and slings may represent life-threatening compression of the esophagus and trachea. Such anatomic variants, although rare, are encountered by all thoracic surgeons in the scope of their practice at some time. The thoracic surgeon, whether treating such patients in the practice of congenital heart surgery, or in the practice of adult cardiac or thoracic surgery must have a requisite understanding of such anatomic variants, their diagnostic workup and radiologic interpretation, as well as their surgical management. Primary tracheobronchial disorders are also frequently encountered in the scope of a thoracic surgical practice and also are discussed.
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Affiliation(s)
- Marvin D Atkins
- Cardiothoracic Surgery, Division of Cardiothoracic Surgery, The Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19014, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Suite 12NW10, Philadelphia, PA 19014, USA.
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29
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Smith MM, Huang A, Labbé M, Lubov J, Nguyen LHP. Clinical presentation and airway management of tracheal atresia: A systematic review. Int J Pediatr Otorhinolaryngol 2017; 101:57-64. [PMID: 28964311 DOI: 10.1016/j.ijporl.2017.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tracheal atresia (TA) is a rare congenital condition that typically requires an unexpected and emergent resuscitation in the delivery room. The mortality rate associated is very high, with only a few long-term survival cases reported. We describe the findings of a systematic review on the clinical presentation and airway management of TA. METHODS Using the keywords "tracheal atresia", "tracheal agenesis" and "tracheal hypoplasia" a search through Embase and Pubmed databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published from 1950 to 2015 in English, French, Italian, Portuguese and Spanish were included. Exclusion criteria were cases of stillborn, and unclear diagnosis or outcome. RESULTS 149 cases of TA were identified after reviewing 1125 initial references. There was a male preponderance (65%), and associated malformations were described in 94.2% of patients. Prenatal ultrasound was abnormal in 56.3% of cases, with polyhydramnios being the most common finding. The most frequent type of TA was Faro Type C. 94 (41.3%) patients did not survive beyond the first 24 h of life. Only 13 (8.4%) patients survived more than three months of life, after undergoing a variety of surgical approaches. CONCLUSION This review, which to our knowledge is the largest one to date, confirms that TA is a rare malformation, occurs more frequently in males, and has a very high mortality rate. Depending on the presence and type of concomitant malformation, as well of the length of the remaining trachea, different surgical management options are described.
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Affiliation(s)
- Mariana M Smith
- Department of Otolaryngology- Head & Neck Surgery, McGill University, Montreal, Canada
| | - Amy Huang
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Mathilde Labbé
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Joshua Lubov
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology- Head & Neck Surgery, McGill University, Montreal, Canada.
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30
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Agarwal A, Nakao M, Rajadurai VS, Chandran S. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth. BMJ Case Rep 2017; 2017:bcr-2016-218818. [PMID: 28408368 DOI: 10.1136/bcr-2016-218818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
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Affiliation(s)
- Arpan Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore .,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
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31
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Jansen G, Schmidt B, Mertzlufft F, Boesing T, Barthel M. [CHAOS in neonatal emergency care? : Tracheal agenesis in the obstetric theatre]. Anaesthesist 2017; 65:763-767. [PMID: 27612864 DOI: 10.1007/s00101-016-0220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tracheal agenesis (TA) is a very rare congenital malformation of unknown aetiology. It is often associated with polymalformative syndromes; the neonates commonly present a critical condition during post-natal treatment. Pathology revolves around the triad of aphonia, respiratory distress syndrome and impossibility of endotracheal intubation. In contrast to the most important differential diagnosis, i. e., congenital high airway obstruction syndrome (CHAOS), surgical airway management is also impossible due to the absence of tracheal structures. In most cases, prognosis is very poor. The case report at hand portrays the treatment of a neonate suffering from tracheal agenesis.
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Affiliation(s)
- G Jansen
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - B Schmidt
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - F Mertzlufft
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - T Boesing
- Klinik für Kinder- und Jugendmedizin, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Deutschland
| | - M Barthel
- Klinik für Kinderchirurgie, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Deutschland
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32
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Bryant R. Tracheal agenesis: Salvaging the unsalvageable. J Thorac Cardiovasc Surg 2017; 153:e127. [PMID: 28242020 DOI: 10.1016/j.jtcvs.2017.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Roosevelt Bryant
- Division of Cardiovascular Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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33
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Grass B, Simma L, Reinehr M, Zimmermann U, Gysin C, Henze G, Cannizzaro V. Two case reports of unexpected tracheal agenesis in the neonate: 3 C's beyond algorithms for difficult airway management. BMC Pediatr 2017; 17:49. [PMID: 28178944 PMCID: PMC5299661 DOI: 10.1186/s12887-017-0806-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Handling neonates with postnatal respiratory failure due to congenital airway malformations implies knowledge about emergency management of unexpected difficult airway. In these stressful situations both technical and communication skills of the caretakers are essential. Case presentation Two cases with prenatally unknown tracheal agenesis are reported. Conclusion In the presented cases, airway malformation and subsequent difficulties upon endotracheal intubation were not adequately communicated between caretakers. We discuss the aspects of culture, communication, and capnography.
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Affiliation(s)
- Beate Grass
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Leopold Simma
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Michael Reinehr
- Department of Pathology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Urs Zimmermann
- Department of Neonatology, Hospital Buelach, Spitalstrasse 24, 8180, Buelach, Switzerland
| | - Claudine Gysin
- Department of Otorhinolaryngology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Georg Henze
- Department of Anesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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34
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Abstract
Tracheal and bronchial pathologies in the neonate can be rapidly fatal if prenatal or quick postnatal diagnosis and intervention is not performed. Close multidisciplinary collaboration between multiple medical and surgical specialties is vital to the effective diagnosis and treatment of these pathologies. The fetal and neonatal airway may be affected or compromised by more prevalent pathologies such as tracheomalacia and tracheo-esophageal fistula with esophageal atresia. However, it is imperative that we also consider other potential sources that may perhaps be less familiar such as congenital cardiovascular abnormalities, tracheal stenosis, complete tracheal rings, tracheal sleeve, and foregut duplication cysts. Modern imaging studies and surgical techniques are allowing us to better serve these children.
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35
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Abstract
Tracheal agenesis is an extremely rare congenital anomaly involving the respiratory system. It is generally associated with anomalies of other systems. Antenatal diagnosis of this condition is difficult; therefore, it presents as a medical emergency in the labor room. Intubation in these babies is difficult. As many of these babies are born prematurely, respiratory distress syndrome (RDS) adds to the management difficulties. Here, we describe two babies with this lethal anomaly and RDS where esophageal intubation and surfactant therapy proved beneficial. Furthermore, described are other associated anomalies.
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Affiliation(s)
- A V Desai
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - Sudha Rao
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - P R Shanbhag
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - M Rupani
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
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36
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Gaerty K, Thomas JT, Petersen S, Tan E, Kumar S, Gardener G, Armes J. Tracheal Atresia with Segmental Esophageal Duplication: An Unusual Anatomic Arrangement. Pediatr Dev Pathol 2016; 19:154-8. [PMID: 26367770 DOI: 10.2350/15-08-1685-cr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An unusual anatomic configuration of segmental tracheal agenesis/atresia with esophageal duplication on autopsy in a fetus that demised in utero at 29 weeks is reported. The mother was scanned initially for a cardiac anomaly at 20 weeks and on follow-up scan at 27 weeks had polyhydramnios and underwent amnioreduction. The final autopsy diagnosis was vertebral, ano-rectal, cardiac, tracheoesophageal, renal, and limb malformations (VACTERL). We discuss the autopsy findings along with the embryological mechanisms and compare the configuration with Floyd's classification for tracheal agenesis. The difficulties in prenatal diagnosis are discussed.
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Affiliation(s)
- Kirsten Gaerty
- 1 Mater Centre for Maternal Fetal Medicine, Mater Health Services, S. Brisbane QLD Australia; and the Mater Research Institute/University of Queensland, Brisbane QLD Australia
| | - Joseph T Thomas
- 1 Mater Centre for Maternal Fetal Medicine, Mater Health Services, S. Brisbane QLD Australia; and the Mater Research Institute/University of Queensland, Brisbane QLD Australia
| | - Scott Petersen
- 1 Mater Centre for Maternal Fetal Medicine, Mater Health Services, S. Brisbane QLD Australia; and the Mater Research Institute/University of Queensland, Brisbane QLD Australia
| | - Edwin Tan
- 2 Anatomical Pathology, Mater Health Services, S. Brisbane QLD Australia.,3 Mater Research Institute, University of Queensland, Brisbane QLD Australia
| | - Sailesh Kumar
- 1 Mater Centre for Maternal Fetal Medicine, Mater Health Services, S. Brisbane QLD Australia; and the Mater Research Institute/University of Queensland, Brisbane QLD Australia
| | - Glenn Gardener
- 1 Mater Centre for Maternal Fetal Medicine, Mater Health Services, S. Brisbane QLD Australia; and the Mater Research Institute/University of Queensland, Brisbane QLD Australia
| | - Jane Armes
- 2 Anatomical Pathology, Mater Health Services, S. Brisbane QLD Australia.,3 Mater Research Institute, University of Queensland, Brisbane QLD Australia
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37
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Windsor A, Clemmens C, Jacobs IN. Rare Upper Airway Anomalies. Paediatr Respir Rev 2016; 17:24-8. [PMID: 26277452 DOI: 10.1016/j.prrv.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022]
Abstract
A broad spectrum of congenital upper airway anomalies can occur as a result of errors during embryologic development. In this review, we will describe the clinical presentation, diagnosis, and management strategies for a few select, rare congenital malformations of this system. The diagnostic tools used in workup of these disorders range from prenatal tests to radiological imaging, swallowing evaluations, indirect or direct laryngoscopy, and rigid bronchoscopy. While these congenital defects can occur in isolation, they are often associated with disorders of other organ systems or may present as part of a syndrome. Therefore workup and treatment planning for patients with these disorders often involves a team of multiple specialists, including paediatricians, otolaryngologists, pulmonologists, speech pathologists, gastroenterologists, and geneticists.
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Affiliation(s)
- Alanna Windsor
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
| | - Clarice Clemmens
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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38
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Park BJ, Kim MS, Yang JH, Jun TG. Tracheal Agenesis Reconstruction with External Esophageal Stenting: Postoperative Results and Complications. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015. [PMID: 26665117 DOI: 10.5090/kjtcs.2015.48.6.439.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tracheal agenesis is an extremely rare and typically lethal congenital disorder. Approximately 150 cases have been described since 1900, and very few cases of survival have been reported. We describe tracheal reconstruction with external esophageal stenting in a patient with Floyd's type II tracheal agenesis. Neither long-term survival nor survival without mechanical ventilation for even a single day has previously been reported in patients with Floyd's type II tracheal agenesis. The infant in the present case survived for almost a year and breathed without a ventilator for approximately 50 days after airway reconstruction using external supportive stents.
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Affiliation(s)
- Byung-Jo Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Min Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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39
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Park BJ, Kim MS, Yang JH, Jun TG. Tracheal Agenesis Reconstruction with External Esophageal Stenting: Postoperative Results and Complications. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:439-42. [PMID: 26665117 PMCID: PMC4672985 DOI: 10.5090/kjtcs.2015.48.6.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
Abstract
Tracheal agenesis is an extremely rare and typically lethal congenital disorder. Approximately 150 cases have been described since 1900, and very few cases of survival have been reported. We describe tracheal reconstruction with external esophageal stenting in a patient with Floyd’s type II tracheal agenesis. Neither long-term survival nor survival without mechanical ventilation for even a single day has previously been reported in patients with Floyd’s type II tracheal agenesis. The infant in the present case survived for almost a year and breathed without a ventilator for approximately 50 days after airway reconstruction using external supportive stents.
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Affiliation(s)
- Byung-Jo Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Min Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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40
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Tazuke Y, Okuyama H, Uehara S, Ueno T, Nara K, Yamanaka H, Kawahara H, Kubota A, Usui N, Soh H, Nomura M, Oue T, Sasaki T, Nose S, Saka R. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction. J Pediatr Surg 2015; 50:2009-11. [PMID: 26590474 DOI: 10.1016/j.jpedsurg.2015.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. MATERIALS AND METHODS We reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. RESULTS The patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed-borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. CONCLUSIONS None of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake.
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Affiliation(s)
- Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keigo Nara
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroaki Yamanaka
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hisayoshi Kawahara
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Akio Kubota
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Hideki Soh
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Sasaki
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Satoko Nose
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryuta Saka
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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41
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Tracheal agenesis: a challenging prenatal diagnosis-contribution of fetal MRI. Case Rep Obstet Gynecol 2015; 2015:456028. [PMID: 25821616 PMCID: PMC4363881 DOI: 10.1155/2015/456028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/20/2015] [Indexed: 11/17/2022] Open
Abstract
Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd's type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology.
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42
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Harjai MM, Badal S, Khanna S, Singh AK. Absent upper blind Pouch in a case of tracheo-esophageal fistula. J Indian Assoc Pediatr Surg 2015; 20:37-9. [PMID: 25552830 PMCID: PMC4268755 DOI: 10.4103/0971-9261.145543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A common upper airway and digestive tract is a rare congenital anomaly that is usually fatal and its exact incidence is not known. It is a diagnostic challenge as it requires high index of suspicion. It should be considered in a neonate with respiratory distress in a non-vigorous baby requiring endotracheal intubation, which is difficult even in expert hand. We present a newborn with suspected tracheo-esophageal fistula that was diagnosed intraoperatively to have absent upper blind pouch of the esophagus and on autopsy found to have laryngeal atresia with absent vocal cords and a common aerodigestive tract continuing distally with trachea. The neonate was ventilated with endotracheal tube (ETT) placement which in retrospect we came to know that it was in the esophagus. The neonate also had associated multiple congenital anomalies of VACTERL association. The importance of teamwork between neonatologist, pediatric surgeon, anesthesiologist, and radiologist is highlighted for diagnosis and management of such rare cases.
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Affiliation(s)
- Man Mohan Harjai
- Department of Surgery and Paediatric Surgery, 166 Military Hospital, 900 277, C/O 56 APO, India
| | - Sachendra Badal
- Department of Pediatrician, 166 Military Hospital, 900 277, C/O 56 APO, India
| | - Sangeeta Khanna
- Department of Anesthesiologist, 166 Military Hospital, 900 277, C/O 56 APO, India
| | - Ajit Kumar Singh
- Department of Anesthesiologist, 166 Military Hospital, 900 277, C/O 56 APO, India
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43
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Ryan DP, Doody DP. Management of congenital tracheal anomalies and laryngotracheoesophageal clefts. Semin Pediatr Surg 2014; 23:257-60. [PMID: 25459009 DOI: 10.1053/j.sempedsurg.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital obstructions and anomalies of the pediatric airway are rare problems that may be associated with mild symptoms or critical stenoses that may be life threatening in the first few days of life. This review provides an overview of the embryologic development of the airway, different congenital anomalies associated with airway development, and surgical correction that may be associated with good long-term outcome.
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Affiliation(s)
- Daniel P Ryan
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts 02114.
| | - Daniel P Doody
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, Massachusetts 02114
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44
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Paoletti D, Robertson M. Congenital high airways obstruction syndrome - first and second trimester diagnosis. Australas J Ultrasound Med 2014. [PMID: 28191213 DOI: 10.1002/j.2205-0140.2014.tb00111.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Congenital High Airways Obstruction Syndrome (CHAOS) is a rare condition associated with high fetal or neonatal mortality. Prenatal diagnosis in the second trimester is made by the typical ultrasound features of large echogenic lungs, a flattened or inverted diaphragm, and fetal ascites or hydrops. We present two cases diagnosed at our institution; one in the second trimester, and a first trimester diagnosis. To the best of our knowledge, first trimester diagnosis of CHAOS has not been previously reported.
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Affiliation(s)
- Debra Paoletti
- Fetal Medicine UnitDivision of Women Youth and ChildrenCanberra Hospital GarranAustralian Capital TerritoryAustralia; Department of Obstetrics and GynaecologyAustralian National UniversityMedical School CanberraAustralian Capital TerritoryAustralia
| | - Meiri Robertson
- Fetal Medicine UnitDivision of Women Youth and ChildrenCanberra Hospital GarranAustralian Capital TerritoryAustralia; Department of Obstetrics and GynaecologyAustralian National UniversityMedical School CanberraAustralian Capital TerritoryAustralia
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45
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Paoletti D, Robertson M. Congenital high airways obstruction syndrome - first and second trimester diagnosis. Australas J Ultrasound Med 2014; 17:82-84. [PMID: 28191213 PMCID: PMC5024938 DOI: 10.1002/j.2205-0140.2014.tb00111.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Congenital High Airways Obstruction Syndrome (CHAOS) is a rare condition associated with high fetal or neonatal mortality. Prenatal diagnosis in the second trimester is made by the typical ultrasound features of large echogenic lungs, a flattened or inverted diaphragm, and fetal ascites or hydrops. We present two cases diagnosed at our institution; one in the second trimester, and a first trimester diagnosis. To the best of our knowledge, first trimester diagnosis of CHAOS has not been previously reported.
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Affiliation(s)
- Debra Paoletti
- Fetal Medicine UnitDivision of Women Youth and ChildrenCanberra Hospital GarranAustralian Capital TerritoryAustralia; Department of Obstetrics and GynaecologyAustralian National UniversityMedical School CanberraAustralian Capital TerritoryAustralia
| | - Meiri Robertson
- Fetal Medicine UnitDivision of Women Youth and ChildrenCanberra Hospital GarranAustralian Capital TerritoryAustralia; Department of Obstetrics and GynaecologyAustralian National UniversityMedical School CanberraAustralian Capital TerritoryAustralia
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46
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Nimbalkar SM, Patel VK, Patel DV, Sethi AR. Tracheal Agenesis with Tracheo-oesophageal Fistula. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2014. [PMID: 24701523 DOI: 10.7860/jcdr/2014/6582.4048.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tracheal Agenesis (TA) presents with respiratory distress at birth. Diagnosis requires recognition of clinical signs in newborns like failure of endotracheal intubation, respiratory distress with absent air entry over both side of chest and inaudible cry. We describe a TA Floyd Type I with a Tracheo-Oesophageal Fistula (TOF) without other congenital malformations.
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Affiliation(s)
| | - Vijay K Patel
- Senior Resident, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
| | - Dipen Vasudev Patel
- Assistant Professor, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
| | - Ankur Rajinder Sethi
- Assistant Professor, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
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47
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Nimbalkar SM, Patel VK, Patel DV, Sethi AR. Tracheal Agenesis with Tracheo-oesophageal Fistula. J Clin Diagn Res 2014; 8:171-2. [PMID: 24701523 DOI: 10.7860/jcdr/2014/6582.4048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/21/2013] [Indexed: 01/08/2023]
Abstract
Tracheal Agenesis (TA) presents with respiratory distress at birth. Diagnosis requires recognition of clinical signs in newborns like failure of endotracheal intubation, respiratory distress with absent air entry over both side of chest and inaudible cry. We describe a TA Floyd Type I with a Tracheo-Oesophageal Fistula (TOF) without other congenital malformations.
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Affiliation(s)
| | - Vijay K Patel
- Senior Resident, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
| | - Dipen Vasudev Patel
- Assistant Professor, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
| | - Ankur Rajinder Sethi
- Assistant Professor, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India
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Coleman AM, Merrow AC, Elluru RG, Polzin WJ, Lim FY. Tracheal agenesis with tracheoesophageal fistulae: fetal MRI diagnosis with confirmation by ultrasound during an ex utero intrapartum therapy (EXIT) delivery and postdelivery MRI. Pediatr Radiol 2013; 43:1385-90. [PMID: 23567909 DOI: 10.1007/s00247-013-2679-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/12/2013] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
Abstract
Tracheal agenesis is a rare and essentially lethal anomaly with divergent prenatal imaging findings depending on the presence or absence of a tracheoesophageal fistula. All prenatally diagnosed cases of tracheal agenesis reported to date have not had a tracheoesophageal fistula and presented with thoracoabdominal findings similar to congenital high airway obstruction syndrome. We present the case of a 32-week gestation fetus with rapid onset of polyhydramnios and no persistent findings of congenital high airway obstruction syndrome that was ultimately diagnosed with tracheal agenesis plus tracheoesophageal fistula by fetal MRI. Additionally, we present the novel uses of intraoperative US during a staged ex utero intrapartum therapy delivery and postdelivery MRI, facilitated by proximity within the neonatal ICU, to confirm diagnosis and direct patient management while minimizing unnecessary investigations.
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Affiliation(s)
- Alan M Coleman
- Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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