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Wu YH, Hsiao CH, Chen YL, Tsai LY, Mu SC. Rare type of tracheal agenesis: Unexpected presentation and immediate consideration of emergent esophageal intubation in neonatal resuscitation program. Case reports and review of the literature. Pediatr Pulmonol 2024; 59:1757-1764. [PMID: 38695627 DOI: 10.1002/ppul.26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/25/2024] [Accepted: 03/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Tracheal agenesis, or tracheal atresia, is a rare congenital anomaly. The presence of a tracheoesophageal fistula (TEF) can help with breathing for newborns with tracheal agenesis. In this article, we presented three unique cases and outcomes of neonates with tracheal agenesis along with a review of the literature. METHODS This study consisted of a single center case series followed by a review of literature. Case reports were generated using both written and electronic medical records from a single hospital. We summarized three unique cases and outcomes of neonates with tracheal agenesis and performed a review of the literature. RESULTS We identified three cases of tracheal agenesis presented with severe cyanosis without spontaneous crying upon birth. Experienced pediatricians attempted to intubate the babies but were unsuccessful. Endotracheal tubes were subsequently either accidentally or purposely placed into the esophagus, and oxygen saturation levels improved. This suggested tracheal agenesis with TEF. Two cases underwent surgical intervention after resuscitation with esophageal intubation. CONCLUSION Esophageal intubation may be a life-sustaining ventilation support for patients with tracheal agenesis and TEF at initial resuscitation. Clinicians should suspect tracheal agenesis when a newborn presents with severe cyanosis and voiceless crying upon birth, and esophageal intubation should be immediately attempted.
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Affiliation(s)
- Yi-Hsin Wu
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ching-Heng Hsiao
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Ling Chen
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Yi Tsai
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Kumbasar U, Uysal S, Doğan R. Congenital pulmonary malformations. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S60-S72. [PMID: 38584784 PMCID: PMC10995677 DOI: 10.5606/tgkdc.dergisi.2024.25713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024]
Abstract
There are many congenital anomalies of the lung, some of which have no clinical symptoms and are detected incidentally, while others, particularly in the neonatal and infant period, are recognized by their typical signs, symptoms, and radiological appearance. Some congenital lung anomalies are so important that they can cause the death of the patient if not diagnosed and treated early. Classification of congenital lung anomalies is difficult since these anomalies may be related to the airway, arterial and venous vascular system, pulmonary parenchyma, and primitive anterior intestinal anomalies from which the lung originates, and some anomalies may have several etiologic origins. In this review, all subgroups of congenital pulmonary malformations will be discussed.
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Affiliation(s)
- Ulaş Kumbasar
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Serkan Uysal
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Rıza Doğan
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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3
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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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4
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Unsuccessful Intubation and Stabilization by Laryngeal Mask Airway in the Delivery Room: A Case of Tracheal Atresia. Case Rep Pediatr 2021; 2021:9983153. [PMID: 34484846 PMCID: PMC8416395 DOI: 10.1155/2021/9983153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022] Open
Abstract
A term male newborn infant was apneic at birth, and endotracheal intubation was unsuccessful. He was stabilized for transport with a laryngeal mask airway. Laryngoscopy revealed tracheal atresia with intrathoracic distal tracheoesophageal fistula. A laryngeal mask airway may provide ventilation in tracheal atresia patients with a fistula.
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5
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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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7
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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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8
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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: 3] [Impact Index Per Article: 0.8] [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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10
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Willer BL, Bryan KG, Parakininkas DE, Uhing MR, Staudt SR, Dominguez KM, McCormick ME, Mitchell ME, Densmore JC, Oldham KT, Berens RJ. Anesthetic Management of an Infant With Postnatally Diagnosed Tracheal Agenesis Undergoing Tracheal Reconstruction: A Case Report. ACTA ACUST UNITED AC 2018; 9:311-318. [PMID: 28719384 DOI: 10.1213/xaa.0000000000000603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis. He underwent staged tracheal reconstruction. He was discharged to home at 4 months of age with a tracheostomy collar, cervical spit fistula, and gastrostomy tube. He represents the sole survivor-to-discharge of tracheal agenesis in the United States. We describe the anesthetic considerations for a patient with tracheal agenesis undergoing reconstruction.
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11
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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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12
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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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13
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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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14
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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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15
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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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16
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Abstract
OBJECTIVE This paper discusses three cases of tracheal agenesis that presented within a six-week period to the Norfolk and Norwich University Hospital. By reviewing the available literature on tracheal agenesis, the report aims to outline a protocol for future prenatal and postnatal management. METHODS A case series and a literature review. RESULTS Three cases of tracheal agenesis presented in the classical manner, with respiratory distress and unsuccessful intubation following delivery. A literature review confirmed that prenatal diagnosis requires future innovation; survival is rare and is predominately reliant on intubation of the oesophagus when a patent tracheoesophageal fistula is present. In most cases, tracheal agenesis represents part of the 'VATER' association: vertebral defects, anal atresia, tracheoesophageal fistula with oesophageal atresia, and radial or renal dysplasia. Complex, multiple-stage surgical procedures have been described; however, no survival to adolescence is documented. CONCLUSION There is a call for improved prenatal diagnosis to allow both adequate counselling of parents and preparation for multi-specialty management at delivery. In addition, these cases highlight the ongoing need for improved congenital anomaly data within the UK, with currently only 49 per cent of England's births being registered.
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17
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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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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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19
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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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20
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Xu GQ, Zhou QC, Zhang M, Pu DR, Ouyang Z. TACRD and VACTERL associations in a fetus: case report and review of the literature. Int J Pediatr Otorhinolaryngol 2013; 77:2081-5. [PMID: 24113157 DOI: 10.1016/j.ijporl.2013.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/13/2013] [Accepted: 09/15/2013] [Indexed: 12/11/2022]
Abstract
Tracheal agenesis is a rare and potentially lethal congenital anomaly. The incidence is less than 1/50,000, with a male:female ratio of 2:1. We report the case of a male fetus with complete agenesis of the trachea and a tracheoesophageal fistula arising from the esophagus that connected through the carina, as well as several abnormalities (congenital cardiac abnormalities, duodenal atresia, vertebral defects, anal atresia, renal defects, limb defects, and diaphragmatic hernia). To our knowledge, few cases of infants with VACTERL or TACRD association have been reported to date. Here, we report a new case of a fetus that showed the full range of VACTERL and TACRD associations.
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Affiliation(s)
- Gan-qiong Xu
- Department of Ultrasonography, Second Xiangya Hospital of Central South University, Changsha, China
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21
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Lange P, Fishman JM, Elliott MJ, De Coppi P, Birchall MA. What can regenerative medicine offer for infants with laryngotracheal agenesis? Otolaryngol Head Neck Surg 2011; 145:544-50. [PMID: 21860060 DOI: 10.1177/0194599811419083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laryngotracheal agenesis is a rare congenital disorder but has devastating consequences. Recent achievements in regenerative medicine have opened up new vistas in therapeutic strategies for these infants. OBJECTIVE To provide a state-of-the-art review concerning recent achievements in tissue engineering as applied to fetal airway reconstruction and to discuss the use of autologous human amniotic stem cells to prepare organs in advance for babies with laryngotracheal agenesis. DATA SOURCES AND REVIEW METHODS A structured search of the current literature (up to and including June 2011). The authors searched PubMed, EMBASE, CINAHL, Web of Science, BIOSIS Previews, Cambridge Scientific Abstracts, ICTRP, and additional sources for published and unpublished trials. RESULTS Over the past 15 years, progress has been made in advancing the boundaries of regenerative medicine from the laboratory to the clinical setting through translational research. Most experience has been gained with adult stem cells and synthetic materials or decellularized scaffolds. The optimal cell source for fetal tissue engineering remains to be determined, but a combination of decellularized scaffolds and amniotic fluid stem cells holds great promise for fetal tissue engineering. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Current treatment strategies for laryngotracheal agenesis are suboptimal, and fetal tissue engineering offers an alternative to conventional treatments. Use of human amniotic fluid stem cells for preparing autologous tissue-engineered organ constructs prenatally is an attractive concept. Although this approach is still in its experimental stages, further preclinical and clinical studies are encouraged to define its exact role in the pediatric laryngological setting.
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22
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Krause U, Rödel RMW, Paul T. Isolated congenital tracheal stenosis in a preterm newborn. Eur J Pediatr 2011; 170:1217-21. [PMID: 21590265 PMCID: PMC3158335 DOI: 10.1007/s00431-011-1490-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/04/2011] [Indexed: 12/05/2022]
Abstract
Severe tracheal stenosis, resulting in functional atresia of the trachea is a rare congenital malformation with an estimated occurrence of two in 100,000 newborns. If no esophagotracheal fistula is present to allow for spontaneous breathing, this condition is usually fatal. We report on a male infant born at 32 weeks of gestation. The patient presented with respiratory distress immediately after delivery due to severe congenital tracheal stenosis resulting in functional atresia of the trachea. Endotracheal intubation failed and even emergency tracheotomy did not allow ventilation of the patient lungs. The patient finally succumbed to prolonged hypoxia due to functional tracheal atresia. The etiology of tracheal atresia and tracheal stenosis is still unclear, but both conditions are frequently combined with other anomalies of the VACTERL (vertebral anomalies, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal/radial anomalies and limb defects) and TACRD (tracheal agenesis, cardiac, renal and duodenal malformations) association. Conclusion Successful treatment of severe congenital tracheal stenosis and tracheal atresia depends on either prenatal diagnosis or recognition of this condition immediately after birth to perform tracheotomy without delay. Nevertheless, despite any efforts, the therapeutical results of severe tracheal stenosis and tracheal atresia are still unsatisfactory.
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Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.
| | - Ralph M. W. Rödel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
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23
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Fuchimoto Y, Mori M, Takasato F, Tomita H, Yamamoto Y, Shimojima N, Hoshino K, Koinuma G, Morikawa Y. A long-term survival case of tracheal agenesis: management for tracheoesophageal fistula and esophageal reconstruction. Pediatr Surg Int 2011; 27:103-6. [PMID: 20857299 DOI: 10.1007/s00383-010-2716-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tracheal agenesis is a very rare disorder which leads to severe respiratory disorders immediately after birth. Reports are very limited on long-term survival cases. We report here a long-term survival case with Floyd's type I tracheal agenesis. During the neonatal stage, the patient underwent abdominal esophageal banding to substitute esophagus for trachea and transection at the cervical esophagus with esophagostomy. Subsequently, airway management was difficult due to a fragile tracheoesophageal fistula, but the fistula was conservatively treated and stabilized with the patient's growth. This patient is a very rare case in whom oral feeding was achieved after esophageal reconstruction using a gastric tube. For this case, we describe mainly (1) the management method of the tracheoesophageal fistula and (2) esophageal reconstruction without thoracotomy.
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Affiliation(s)
- Yasushi Fuchimoto
- Department of Pediatric Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, 160-8582, Japan.
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24
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Three-stage reconstruction of the airway and alimentary tract in a case of tracheal agenesis. Ann Thorac Surg 2010; 89:2019-22. [PMID: 20494075 DOI: 10.1016/j.athoracsur.2009.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/21/2009] [Accepted: 11/04/2009] [Indexed: 10/19/2022]
Abstract
In the few surviving cases of tracheal agenesis, infants have not been capable of oral intake because the esophagus was used as a substitute for the trachea. We performed a three-stage reconstruction of the airway and alimentary tract in an infant with tracheal agenesis. This procedure involved a double cervical esophagostomy followed by an anastomosis of the upper mid-esophagus and carinal trachea. Finally, the esophagus was reconstructed by an anastomosis of the cervical esophagus to the lower esophagus. This novel procedure may become a highly effective surgical treatment for some infants in critical condition due to tracheal agenesis.
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25
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Use of computed tomography to categorize the type of tracheal agenesis. J Pediatr Surg 2009; 44:1044-6. [PMID: 19433196 DOI: 10.1016/j.jpedsurg.2009.01.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/21/2009] [Accepted: 01/23/2009] [Indexed: 11/23/2022]
Abstract
We report a case of type I tracheal agenesis with vertebral defects, anal atresia, tracheoesophageal fistula and/or esophageal atresia, radial dysplasia, renal defects, and cardiovascular defects association in which computed tomography was helpful in categorizing the diagnosis. This rare and fatal condition should always be considered when confronted with a neonate impossible to resuscitate at birth.
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26
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Abstract
UNLABELLED Tracheal agenesis is a rare and in most cases lethal anomaly. It may be suspected because of lack of audible crying, and is often diagnosed right after birth with water soluble contrast medium injected into the oesophagus. We report two cases which were identified at our institution in the last 10 years. Imaging studies and medical records were reviewed in both cases. Patient number one was studied with a single slice computed tomography, patient number two with multislice detector computed tomography (MDCT) with 64 rows. The advantage of MDCT in demonstrating the rare condition of tracheal agenesis and with the same examination showing other coexisting anomalies is discussed. CONCLUSION MDCT with 64 rows is an excellent diagnostic tool in diagnosing tracheal agenesis and showing other coexisting anomalies at the same time.
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Affiliation(s)
- Jörg Daniel Geisler
- Division of Medical Imaging and Intervention, Oslo University Hospital, Oslo, Norway
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27
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Abstract
UNLABELLED Tracheal agenesis is a rare and in most cases lethal anomaly. It may be suspected because of lack of audible crying, and is often diagnosed right after birth with water soluble contrast medium injected into the oesophagus. We report two cases which were identified at our institution in the last 10 years. Imaging studies and medical records were reviewed in both cases. Patient number one was studied with a single slice computed tomography, patient number two with multislice detector computed tomography (MDCT) with 64 rows. The advantage of MDCT in demonstrating the rare condition of tracheal agenesis and with the same examination showing other coexisting anomalies is discussed. CONCLUSION MDCT with 64 rows is an excellent diagnostic tool in diagnosing tracheal agenesis and showing other coexisting anomalies at the same time.
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28
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29
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Bober K, Musialik-Swietlińska E, Adamiec-Poniewierka E, Pajak J, Bielecki I, Koszutski T, Wiecek-Włodarska D, Goc B, Szydłowski L, Swietliński J. Tracheal agenesis: perioperative management of one stage correction. Paediatr Anaesth 2008; 18:982-3. [PMID: 18811835 DOI: 10.1111/j.1460-9592.2008.02586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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30
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Watanabe T, Okuyama H, Kubota A, Kawahara H, Hasegawa T, Ueno T, Saka R, Morishita Y. A case of tracheal agenesis surviving without mechanical ventilation after external esophageal stenting. J Pediatr Surg 2008; 43:1906-8. [PMID: 18926230 DOI: 10.1016/j.jpedsurg.2008.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 06/10/2008] [Accepted: 06/11/2008] [Indexed: 11/27/2022]
Abstract
Tracheal agenesis is a rare and usually lethal congenital malformation of the forgut. Although some infants can be resuscitated with an intra-esophageal intubation temporarily, long-term airway management is difficult because of the collapsing airway. We report a long-term survivor with tracheal agenesis in whom a Gortex external esophageal stent using radial traction sutures was applied to prevent the esophagus from collapsing. The patient was discharged from our hospital without mechanical ventilation or oxygen inhalation at 10 months of age. Our procedure has a potential to establish a long-term steady airway in patients with tracheal agenesis. The detail of the procedure is presented and the related literature is reviewed.
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Affiliation(s)
- Takashi Watanabe
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, 594-1101, Osaka, Japan
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31
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Rupérez Lucas M, Bonet Serra B, Martínez Orgado JA, Guerrero Márquez C. [Tracheal agenesis associated with laryngeal malformations as an unusual cause of airway failure]. An Pediatr (Barc) 2008; 67:236-9. [PMID: 17785161 DOI: 10.1016/s1695-4033(07)70613-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Tracheal agenesis is an uncommon congenital malformation with an extremely high mortality rate. This malformation manifests after delivery as severe respiratory distress, cyanosis, lack of crying and impossibility of endotracheal respiratory support. This anomaly is usually associated with cardiovascular, respiratory and gastrointestinal malformations. Only a high index of suspicion and early surgical management will prevent death. An early diagnosis may also help the parents and the medical team to take appropriate decisions. Currently, there is no effective therapy that guarantees long-term survival.
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Affiliation(s)
- M Rupérez Lucas
- Servicio de Neonatología, Fundación Hospital Alcorcón, Madrid, España.
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32
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Pratap A, Saha GS, Bhattarai BK, Yadav RP, Nepal A, Bajracharya A, Kumar A, Adhikary S. Tracheal agenesis type B: further evidence to a lethal congenital tracheal malformation. J Pediatr Surg 2007; 42:1284-7. [PMID: 17618898 DOI: 10.1016/j.jpedsurg.2007.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tracheal agenesis is an extremely rare, typically fatal congenital tracheal malformation. Lack of prenatal symptoms and emergent presentation usually lead to a failure to arrive at the correct diagnosis and manage the airway properly before the onset of irreversible cerebral anoxia. We report the case history of an infant born with immediate respiratory failure who was diagnosed with tracheal agenesis. The clinical presentation, embryology, classification, and surgical management are discussed.
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Affiliation(s)
- Akshay Pratap
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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33
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Heimann K, Bartz C, Naami A, Peschgens T, Merz U, Hörnchen H. Three new cases of congenital agenesis of the trachea. Eur J Pediatr 2007; 166:79-82. [PMID: 16896644 DOI: 10.1007/s00431-006-0210-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 06/07/2006] [Indexed: 11/30/2022]
Abstract
Congenital absence of the trachea is a rare anomaly that might confront the obstetrician or neonatologist with an unexpected emergency. These patients present with cyanosis, severe respiratory distress, insufficient gas exchange, absence of audible crying and difficult or impossible endotracheal intubation. In more than 90% it is associated with further congenital malformations. Adequate oxygenation depends on the existence of a tracheo- or bronchooesphageal fistula and the length of the proximal trachea. We present the cases of three neonates with tracheal agenesis with tracheooesophageal fistula. Two of the neonates died within the first hour of life because endotracheal intubation was impossible and oxygenation through an oesophageally placed tube was insufficient. The third infant could be oxygenated through a tracheooesophageal fistula. The ventilation was at least insufficient and no surgical intervention was made. The diagnosis of a congenital absence of the trachea usually is made after birth because of the clinical signs and the course within the first minutes of life. The only way that the diagnosis can be made prenatally is by magnetic resonance imaging (MRI). The knowledge of this clinical picture helps to make decisions in an unexpected emergency in the immediate postpartum period and also in patients whose ventilation is very difficult right from the start.
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Affiliation(s)
- Konrad Heimann
- Department for Neonatal and Conservative Pediatric Intensive Care, University Hospital, Medical Faculty RWTH, 52074 Aachen, Germany.
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34
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Felix JF, van Looij MAJ, Pruijsten RV, de Krijger RR, de Klein A, Tibboel D, Hoeve HLJ. Agenesis of the trachea: phenotypic expression of a rare cause of fatal neonatal respiratory insufficiency in six patients. Int J Pediatr Otorhinolaryngol 2006; 70:365-70. [PMID: 16125794 DOI: 10.1016/j.ijporl.2005.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 07/09/2005] [Indexed: 12/24/2022]
Abstract
Tracheal agenesis is a rare congenital malformation, which is usually fatal in the newborn period. Its incidence is approximately 1 in 50,000 births. Presentation is with respiratory insufficiency and no audible cry. Other anomalies are found in most cases. Six cases of tracheal agenesis were seen in our hospital since 1988. Their medical records were reviewed. Three of our cases classify as Floyd's type III, two as Floyd's type II and one as Floyd's type I. Associated anomalies were found in five cases. The classification of tracheal agenesis, associated anomalies and potential therapeutic options are discussed.
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Affiliation(s)
- Janine F Felix
- Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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35
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Abstract
A premature infant with a unique form of tracheal agenesis is described. The combination of difficulty in intubation, abnormal course of the nasogastric tube on plain x-ray, and gastric perforation raised the suspicion of an upper airway malformation. Tracheal agenesis is an extremely rare, typically fatal, congenital anomaly with scattered case reports of its successful management. On many occasions, the diagnosis is a retrospective one at postmortem examination. The possibility of surgical correction rests on early diagnosis, anatomy, birth weight, and associated anomalies. Early recognition is mandatory, but in our case, the low birth weight precluded consideration for reconstructive surgery.
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Affiliation(s)
- Nia Fraser
- Department of Paediatric Surgery, Nottingham Hospitals NHS Trust, Queens Medical Centre, NG7 2UH Nottingham, UK.
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36
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Abstract
OBJECTIVES/HYPOTHESIS A series of three newborns with tracheal agenesis is described. The preferred methods of diagnosis, description of the clinical course, and a review of the pertinent embryology, associated anomalies, and clinical management are presented. STUDY DESIGN A retrospective study of a clinical series of referred patients from 2002 to 2003 who were seen at a single institution. METHODS Chart review for clinical course and pathological specimens was performed in all cases. Three patients were identified with tracheal agenesis. RESULTS All three newborns died within 48 hours of birth. All of the children underwent emergency laryngoscopy and neck exploration. Gross and microscopic pathological examination was accomplished on all patients. CONCLUSION Although tracheal agenesis is rare, it may be more common than previously thought. The diagnosis is not straightforward, and the prognosis is grim. The embryology of the trachea and other foregut derivatives is closely related, and associated birth defects are common.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/pathology
- Abnormalities, Multiple/surgery
- Diagnosis, Differential
- Emergencies
- Fatal Outcome
- Female
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/pathology
- Infant, Premature, Diseases/surgery
- Intubation, Intratracheal
- Laryngoscopy
- Male
- Prognosis
- Resuscitation
- Trachea/abnormalities
- Trachea/pathology
- Trachea/surgery
- Tracheoesophageal Fistula/diagnosis
- Tracheoesophageal Fistula/pathology
- Tracheostomy
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Affiliation(s)
- Timothy A Lander
- Pediatric ENT Associates, PA, Minneapolis/St. Paul, Minnesota, USA.
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37
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Baroncini-Cornea S, Fae M, Gargiulo G, Gentili A, Lima M, Pigna A, Pilu G, Tancredi S, Turci G. Tracheal agenesis: management of the first 10 months of life. Paediatr Anaesth 2004; 14:774-7. [PMID: 15330961 DOI: 10.1111/j.1460-9592.2004.01281.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life.
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Affiliation(s)
- S Baroncini-Cornea
- Department of Anaesthesia and Intensive Care, S. Orsola Malpighi University Hospital, Bologna, Italy.
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38
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Wei JL, Rodeberg D, Thompson DM. Tracheal agenesis with anomalies found in both VACTERL and TACRD associations. Int J Pediatr Otorhinolaryngol 2003; 67:1013-7. [PMID: 12907059 DOI: 10.1016/s0165-5876(03)00180-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tracheal agenesis (TA) was diagnosed by endoscopy after esophageal intubation in a 34-week newborn. Diagnosis, work-up, and management approach are discussed. Similar to previous reports, this case of tracheal agenesis presented with multiple associated defects found at autopsy. Tracheal agenesis had previously been reported as a part of the VATER (vertebral defects, anal atresia, tracheoesophageal fistula and/or esophageal atresia, radial dysplasia, renal defects) and VACTERL (VATER plus cardiovascular and limb defects) associations/syndromes. More recently, cases of TA have been reported with associated anomalies described as TACRD (tracheal agenesis/atresia, complex congenital cardiac abnormalities, radial ray defects, and duodenal atresia) association/syndrome. We present a case of TA with anomalies found in both VACTERL and TACRD associations, which support the speculation that both are different manifestations of a spectrum of mesodermal dysplasia.
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Affiliation(s)
- Julie L Wei
- Division of Pediatric Otolaryngology, Childrens Memorial Hospital, 2300 Childrens Plaza, Box 25, Chicago, IL 60614, USA.
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Affiliation(s)
- C Michael Haben
- Department of Pediatric Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
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