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doi: 10.21037/jtd.2017.01.13.

Electric current concepts in astringent adult tracheobronchomalacia: evaluation and handling

Affiliations

• PMID: 28203438
• PMCID: PMC5303067
• DOI: 10.21037/jtd.2017.01.thirteen

Complimentary PMC article

Review

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

Daniel H Buitrago  et al. J Thorac Dis. 2017 Jan .

Costless PMC article

Abstract

There is increasing recognition of tracheobronchomalacia (TBM) in patients with respiratory complaints, though its true incidence in the adult population remains unknown. Most of these patients have an acquired course of astringent lengthened TBM of unclear etiology. The mainstays of diagnosis are dynamic (inspiratory and expiratory) airway computed tomography (CT) browse and dynamic flexible bronchoscopy with forced expiratory maneuvers. While the prevailing definition of TBM is 50% reduction in cross-sectional surface area, a high proportion of healthy volunteers run into this threshold, thus this threshold fails to identify patients that might benefit from intervention. Therefore, we consider consummate or near-consummate collapse (>xc% reduction in cantankerous-exclusive surface area) of the airway to be severe enough to warrant potential intervention. Surgical central airway stabilization by posterior mesh splinting (tracheobronchoplasty) finer corrects malacic airways and has been shown to lead to significant comeback in symptoms, health-related quality of life, too as functional and exercise capacity in advisedly selected adults with severe diffuse TBM. A brusk-term stent trial clarifies a patient'southward candidacy for surgical intervention. Coordination of intendance between experienced interventional pulmonologists, radiologists, and thoracic surgeons is essential for optimal outcomes.

Keywords: Expiratory central airway collapse (ECAC); astringent lengthened tracheobronchomalacia (TBM); tracheobronchoplasty (TBP).

Conflict of interest statement

Disharmonize of Interest: The authors have no conflict of interest to declare.

Figures

Effigy one

Schematic representation of (A) normal airway and (B) malacic airway pathology. Representative cross section images obtained during dynamic computed tomography (CT) scan and dynamic bronchoscopy accompany the airway diagrams.

Figure 2

Beth State of israel Deaconess Medical Eye (BIDMC) Institutional protocol for evaluation of patients with severe diffuse tracheobronchomalacia (TBM).

Figure iii

Schematic of expiratory central airway collapse (ECAC). (A) Elevation: airway represents the form of tracheobronchomalacia (TBM) characterized by weakness that affects primarily the inductive tracheobronchial wall. A representative cross sectional CT image accompanies the diagram. Bottom: diagram represents the form of TBM characterized by invagination of the atrophic posterior membrane into airway lumen. A representative cantankerous exclusive computed tomography (CT) prototype accompanies the diagram; (B) tracheobronchoplasty. Suture is seen passed in a partial thickness mattress fashion through the airway wall. Typically, the entire thoracic trachea is splinted, then the right mainstem and bronchus intermedius, and so left mainstem bronchus [Reprinted with permission (28)].

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Source: https://pubmed.ncbi.nlm.nih.gov/28203438/

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