A Case of Tracheomalacia in Chronic Obstructive Pulmonary Disease: What Went Wrong?

Abstract

Tracheobronchomalacia is defined as loss of the structural integrity of airway wall cartilaginous structures with hyperdynamic airway collapse during respiration. It is a common finding in chronic obstructive pulmonary disease (COPD) but is not always symptomatic, especially if airway narrowing is mild. Symptoms and signs develop as the severity of airway narrowing progresses. When a patient is symptomatic, a prompt study with computerized tomography and flexible bronchoscopy is mandatory for future management. We present a case of tracheobronchomalacia in a patient with COPD whose diagnosis and treatment were challenging.

Learning points: Tracheobroncomalacia is a common finding in chronic obstructive pulmonary disease patients; management of the obstructive disorder is the first treatment step.When patients remain symptomatic, non-invasive positive pressure ventilation can be applied; if there is no response, a stent trial or surgical procedure should be considered.It is a challenge to identify which patients should undergo invasive intervention or surgical management.

Keywords: Tracheobroncomalacia; airway obstruction; bronchoscopy.

Figure 1

Cross-sectional CT image showing a saber-sheath trachea

Figure 2

Cross-sectional CT image showing the lateral walls collapsing inside the lumen

Figure 3

Rigid bronchoscopy image showing a saber-sheath trachea under jet ventilation