Tracheomalacia

Tracheomalacia is a condition characterized by excessive collapse of the tracheal walls during expiration due to weakness of tracheal cartilage and supporting tissues. The resulting airway obstruction is dynamic and can fluctuate with breathing, coughing, or activity. It may be isolated or part of tracheobronchomalacia; congenital and acquired forms exist.

Causes include congenital cartilage weakness (primary tracheomalacia) and acquired forms from prolonged intubation or tracheostomy, chest trauma, infections, inflammatory diseases, or external compression by vascular anomalies, mediastinal masses, or thyroid enlargement.

Clinical features include in infants a harsh barky cough, inspiratory or expiratory wheeze, stridor, recurrent infections, and sometimes cyanosis or feeding difficulties; symptoms often worsen with crying or agitation. In adults, chronic cough, wheeze, dyspnea, and recurrent infections may be present.

Diagnosis relies on dynamic visualization. Flexible bronchoscopy demonstrates expiratory tracheal collapse and assesses severity; dynamic CT or MRI can show lumen reduction during expiration. Pulmonary function tests may reveal variable obstruction, though results are often nonspecific.

Management ranges from observation and infection treatment for mild disease to noninvasive airway support and airway clearance techniques. Severe cases may require interventional procedures such as aortopexy or tracheopexy, tracheal stenting, or surgical reconstruction, with prognosis depending on age and underlying cause.