Tracheomalacia in Adults: An Uncommon Cause of Dyspnea

Abstract

Tracheomalacia (TM), the most common congenital tracheal defect, is due to compromised cartilage integrity, manifesting in the narrowing of expiratory airways and various respiratory symptoms. While TM is common in infants and toddlers, it is rarely found in adults, often due to acquired injuries or chronic lung diseases. We present a unique case of a 67-year-old man with persistent dyspnea and hoarseness for two years. Despite a history of smoking, he had no signs of pulmonary disease and had a consistently high oxygen saturation during episodes of dyspnea. His dyspnea was of unknown etiology until a diagnostic bronchoscopy revealed tracheal stenosis and flaccidity of cartilaginous structures, with pronounced collapse during expiration. This atypical presentation highlights the complexity of TM in adults. It underscores the importance of considering it as a differential diagnosis, particularly in male smokers with gradual, persistent dyspnea and a minimal history of pulmonary disease.

Keywords: cartilaginous disorders; dyspnea of unknown origin; ear nose throat (ent); general internal medicine; otolaryngology; tracheomalacia.

Figure 1. Patent tracheal expansion during the inspiratory phase

Figure 2. Lateral wall trapezoidal collapse during the expiratory phase