Diagnostic Approach to Tracheomalacia and Medical Management

Tracheomalacia is the dynamic collapse of the trachea during the respiratory cycle. It is common in children due to ongoing development of the trachea and differences in the structure of tracheal cartilage and smooth muscle compared to adults. Underlying or congenital anomalies, such as tracheoesophageal fistula and bronchopulmonary dysplasia, can cause additional alterations in tracheal structure resulting in an increased prevalence of tracheomalacia. The evaluation and management of tracheomalacia is multifaceted. Clinical presentation and symptom report are typically the driving factors in assessment and treatment. Symptoms are variable, often related to the severity of tracheomalacia. There is no one single test to diagnose tracheomalacia; a variety of diagnostic methods can be utilized, including direct assessment with bronchoscopy and imaging modalities such as chest computed tomography and magnetic resonance imaging. Each of these modalities has advantages and disadvantages, and often a combination of techniques provides the most complete understanding. There are several options available for medical management in patients, typically guided by symptoms. While there are multiple choices available, there is no single gold standard therapy available, and there is typically limited evidence for use in patients with tracheomalacia.