Pediatric Pulm (little lungs) Flashcards
What is Tracheomalacia?
Tracheomalacia is a relatively common anomaly of the upper respiratory tract characterized by a dynamic collapse of the trachea during expiration, resulting in airway obstruction. Intrathoracic lesions typically present with recurrent harsh, barking, or croup-like cough, whereas extrathoracic lesions cause wheezing with expiratory stridor common if laryngomalacia is present. This condition should be suspected in children with chronic wheezing.
Bronchoscopic visualization of dynamic airway compromise is the diagnostic gold standard for tracheomalacia (TM). TM is considered mild if the operator estimates that the lumen narrows to 50 percent of its initial size during expiration, moderate if it narrows to 25 percent of its initial size, and severe if the anterior and posterior walls touch. Treatment is routine follow-up with surgical options only considered if airway compromise is evident, which is rare.
In children who aspirate a foreign body what procedure should we do?
In this young patient who has sudden-onset wheezing and shortness of breath and who has been playing mostly unsupervised, foreign-body aspiration (FBA) should be considered high on the differential diagnosis, whether or not a foreign body was known to be with the child. Children often find things that parents were not aware of and attempt to eat them, which can result in esophageal obstruction. If the foreign body is accidentally inhaled, tracheal or bronchial obstruction can result.
In children with sudden onset of lower-respiratory symptoms, FBA should be suspected, and rigid bronchoscopy should be pursued in stable patients whose conditions elicit high clinical suspicion of FBA. History of choking followed by respiratory symptoms is highly suggestive of FBA; however, the absence of choking does not rule out FBA.
In patients who are suspected to have FBA and whose condition (whether asymptomatic or symptomatic) is stable, the first step in the evaluation is to obtain a chest radiograph. A negative chest radiograph does not rule out FBA, especially if there is a high clinical suspicion, as radiolucent objects will not be easily detected on conventional radiographs.
