Paediatric Tracheal and Oesophageal Pathology

67 Paediatric Tracheal and Oesophageal Pathology


67.1 Tracheobronchomalacia


• Cartilage to muscle ratio should be 2:1


• Secondary condition may occur secondary to external compression—vascular/mediastinal mass/ventilation, e.g., double aortic arch


• Usually improves by 18 months


• Larsen syndrome


• TOF


• Symptoms/signs:


figure Cyanotic episodes


figure Cough


figure Aspiration


figure Timing of stridor—prolonged expiratory phase seen on Ba swallow


figure MLB required—avoid airway splinting—underdiagnosis


67.2 Tracheoesophageal Fistula (TOF)


67.2.1 Epidemiology and Aetiology


• Majority associated with oesophageal atresia (96–97%)


• 1 in 3000/4000 births


• Failure of complete separation of foregut from respiratory tract


• 40% have other malformations


figure OA + distal TOF 87%


figure OA alone 6–7%


figure OA + prox TOF 2%


figure OA + prox + distal TOF <1%


figure TOF alone 3–4%


• Infants often premature and have polyhydramnios


• Associated malformations:


figure V: vertebral


figure A: anal


figure C: cardiac


figure T: trachea


figure E: oesophageal


figure R: renal


figure L: limb


67.2.2 Symptoms


• Often asymptomatic at birth


• Respiratory:


figure Cough; choke; cyanosis (when feeding); aspiration (leading to respiratory distress, atelectasis, pneumonia)


• GI:


figure Excessive drooling, gastric distension—respiratory compromise


67.2.3 Investigation


• Oesophageal catheter, i.e., NG tube, and check position on plain CXR


• AXR: air stomach/small bowel suggests distal fistula. Lack of air in stomach suggests oesophageal atresia


• Bronchoscopy + oesophagoscopy


• ECHO diagnoses any cardiac abnormalities + position of aortic arch


• GG swallow (risk of aspiration)


67.2.4 Waterson Classification


• Pretreatment risk evaluation


figure Category A


– Birth wt >5.5 lb (2.5 kg)

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Paediatric Tracheal and Oesophageal Pathology

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