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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of localized tracheomalacia, one associated with esophageal atresia, and one isolated. The pathophysiology explains that the symptoms are more important during or shortly after eating, the alimentary bowl crushing the trachea against the aorta, or the innominate artery. The exact cause of tracheomalacia is unknown. Esophageal atresia is frequently associated. The tracheal compression is more often due to the innominate artery, because its origin is located on the left side of the trachea in infants. The aorta or a vascular anomaly are rarely implicated. The symptoms of tracheomalacia are largely due to airway obstruction during expiration: stridor, baking cough, and the life-threatening "dying spell". For diagnosis, the endoscopy is the most important investigation. Among the many methods of treatment which have been proposed, the aortopexy appears to be the technique giving the best results. A single acute apneic attack is an absolute indication for surgery. It is also important to rule out severe gastroesophageal reflux, which can produce the same symptoms.
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PMID:[Value of aortopexy in infants in the treatment of segmental tracheomalacia]. 801 73

A 71-year-old male had suffered from cough with purulent sputum. He was admitted to our hospital because of worsening of his symptoms. The chest X-ray film showed diffuse nodular shadows and emphysematous changes in both lung fields. Transbronchial lung biopsy demonstrated findings compatible with diffuse panbronchiolitis (DPB). Bronchoscopy showed the tracheal lumen was sagittaly narrowed and membranous portion was protruded into the lumen. The trachea completely collapsed when coughing. His disease was diagnosed as saber-sheath type tracheomalacia (Johnson III). Tracheomalacia was reported to be observed in 0.9% of patients examined by bronchoscopy. The dominant type of tracheomalacia is crescent type, and saber-sheath type is rare. Chronic airway inflammation with DPB might have exacerbated the tracheomalacia in this case.
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PMID:[A case of diffuse panbronchiolitis associated with tracheomalacia]. 829 57

Narrowing of the trachea due to tracheomalacia or compression can lead to life-threatening asphyxia and may require tracheotomy with intubation or endoscopic introduction of a stent. The use of a self-expanding elastic metal prosthesis in 4 patients with airway obstruction has proved a satisfactory alternative to conventional plastic prostheses, both in the acute phase and over a long period of time. After 4 weeks total epithelium cover of the stent could be demonstrated; biopsies after 3 and 4 months showed differentiation into respiratory ciliated epithelium. Patient acceptance was excellent since there was no sensation of a foreign body, retention of secretions or cough. The physical properties of the wall stent made it a suitable mechanical replacement for an unstable or narrowed trachea during the period of observation.
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PMID:[The implantation of elastic metal endoprostheses in tracheal stenosis and tracheomalacia. The initial results with 4 patients]. 833 57

Neonatal tracheomalacia is a disease in which there is a softening of the tracheal wall with lost of this consistency. This cause expiratory collapse cough and respiratory difficulty it is generally associated with Esophageal atresia and Vascular Rings. Exceptionally is a primary disease. In this paper we present three cases of neonatal tracheomalacia treated by aortopexy who is at the moment the best treatment that we have in severe cases. Soft cases will remit with conservative treatment.
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PMID:[Neonatal tracheomalacia. Study of 3 cases treated with aortopexy+]. 835 29

External splinting of the trachea has been used alone or in combination with aortopexy for the treatment of severe tracheomalacia. The authors describe the case of a 12-year-old boy who had a Marlex mesh splint placed because of life-threatening primary tracheomalacia at 6 months of age. He presented at 12 years of age with a 5-month history of shortness of breath on exertion, dry cough, and audible wheeze. Radiological and endoscopic examinations showed near-complete obstruction of the orifice of the right mainstem bronchus by a large polypoid granuloma. Initially the patient was treated with endoscopic resection on two occasions, but the granuloma and bronchial obstruction recurred each time. He underwent a right thoracotomy, which showed that the lower edge of the mesh had eroded through the trachea wall and was acting as a nidus for granuloma formation. After removal of the mesh, the resulting defect at the site of erosion of the trachea was closed with a pericardial patch. The postoperative course was uncomplicated, and the patient remains well 2 years after surgery. External splinting of the trachea has been shown to be effective in the treatment of complicated tracheomalacia, but one must be aware of the potential long-term complications, as demonstrated in this case.
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PMID:Intratracheal granuloma formation: a late complication of Marlex mesh splinting for tracheomalacia. 894 25

Cough is an uncommon sign in infants. Cough may result from the presence of abnormal secretions in the airway or abnormalities of the central airways that affect the infant's ability to clear normal secretions. Tracheomalacia (TM) and gastroesophageal reflux (GER) can both cause cough in infants. Four infants whose cough began in the newborn period were diagnosed with TM and GER. Symptoms of central airway obstruction (homophonous wheeze or tracheal cough) suggested the diagnoses. In three patients, the diagnosis was made by barium esophagraphy and airway fluoroscopy. The infants responded to conservative and medical therapy for GER and to nebulized bronchodilators. Tracheomalacia and GER cause cough in infants that begins in the newborn period. The diagnosis can often be made with studies available to the primary care provider, and the conditions are often responsive to medical management.
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PMID:Primary tracheomalacia and gastroesophageal reflux in infants with cough. 986 47

Four neonates, one girl and three boys, displayed symptoms such as coughing during feeding and bubbleblowing; in two of their mothers there had been positive discongruence during pregnancy. The children had an oesophageal atresia and/or tracheo-oesophageal fistula, which were corrected surgically. In one of the two children with a longer distance between the proximal and distal parts of the oesophagus, complications continued to occur; the others recovered reasonably well. The first successful creation of an anastomosis in oesophageal atresia was performed in 1941. Due to the improvement in the treatment the mortality in the past decennia has lowered. An increased morbidity has become apparent. The attention is nowadays focussed on the treatment of morbidity such as strictures, leakage of the anastomoses, gastro-oesophageal reflux, tracheomalacia and recurrent fistula.
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PMID:[Morbidity in children after surgical treatment of esophageal atresia and tracheoesophageal fistula]. 1087 98

A number of disorders of the respiratory tract and some even outside the respiratory tract can cause cough. A systematic approach towards a patient of chronic cough consisting of detailed history, physical examination of upper as well as lower respiratory tract, complete blood counts, tuberculin test, chest X-ray, and peak flow rate testing will give the diagnosis in majority of children. Pulmonary tuberculosis and asthma are the two commonest conditions diagnosed. If the initial work up is inconclusive, further laboratory testing and imaging studies should be considered. Thus, radiolabelled milk scan, barium swallow and 24-hour pH monitoring would diagnose gastroesophageal reflux. Spirometry, methacholine/exercise challenge test or a therapeutic trial may be required for confirming bronchial asthma. Flexible bronchoscopy is useful for evaluation for suspected aspiration syndromes and any anatomical or dynamic problem of the airway (e.g. tracheomalacia). Spiral and high resolution computed tomography (HRCT) along with magnetic resonance imaging are the modern day imaging techniques used for studying mediastinal masses, airway obstruction and even lung parenchyma (HRCT). Sputum examination for type of cells and bacteria can be useful, especially if pseudomonas or acid-fast bacilli are identified. Pseudomonas suggests cystic fibrosis (an uncommon disease in India) which can be confirmed by sweat chloride test and gene mutation studies.
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PMID:Clinical approach to a patient with cough. 1141 72

Laryngomalacia, bronchomalacia, and tracheomalacia are commonly seen in pediatric respiratory medicine, yet their patterns and associations with other conditions are not well-understood. We prospectively video-recorded bronchoscopic data and clinical information from referred patients over a 10-year period and defined aspects of interrelationships and associations. Two hundred and ninety-nine cases of malacia disorders (34%) were observed in 885 bronchoscopic procedures. Cough, wheeze, stridor, and radiological changes were the most common symptoms and signs. The lesions were most often found in males (2:1) and on the left side (1.6:1). Concomitant malacia lesions ranged from 24% for laryngotracheobronchomalacia to 47% for tracheobronchomalacia. The lesions were found in association with other disorders such as congenital heart disorders (13.7%), tracheo-esophageal fistula (9.6%), and various syndromes (8%). Even though the understanding of these disorders is in its infancy, pediatricians should maintain a level of awareness for malacia lesions and consider the possibility of multiple lesions being present, even when one symptom predominates or occurs alone.
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PMID:Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. 1220 47

Infantile tracheomalacia is a potentially life-threatening disease requiring prolonged artificial respiratory support. Diagnosis and management of this disease may be further improved by establishing a suitable objective and quantitative assessment protocol for tracheal collapsibility. It is our hypothesis that tracheal collapsibility can be represented by the relationship between intraluminal pressure and the cross-sectional area of the trachea. To test this hypothesis, static pressure/area relationships of the trachea were obtained from anesthetized and paralyzed infants, who were diagnosed as having tracheomalacia by endoscopic observation. These relationships were fitted on a linear regression model, followed by calculation of the estimated closing pressure. The tracheal closing pressure ranged from -8 to -27 cm H(2)O, suggesting easy collapsibility of the trachea during crying or coughing and noncollapsibility during the spontaneous respiratory cycle, which coincided with the infants' symptoms. It is our conclusion that tracheal collapsibility of infants with tracheomalacia can be quantitatively assessed by the static pressure/area relationship of the trachea obtained under general anesthesia and paralysis.
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PMID:Quantitative assessment of tracheal collapsibility in infants with tracheomalacia. 1524 42


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