Tracheobronchomalacia in children: review of diagnosis and definition

Area of Science:

• Pediatric Pulmonology
• Medical Imaging
• Respiratory Physiology

Background:

• Tracheobronchomalacia involves excessive airway collapsibility due to weakened airway walls and cartilage.
• The current diagnostic standard requires a 50% reduction in cross-sectional area during expiration.
• Normal airway collapse ranges in children are not well-defined, making pathological thresholds arbitrary.

Purpose of the Study:

• To highlight the lack of validated criteria for diagnosing tracheobronchomalacia.
• To underscore the need for defining normal airway collapse ranges in pediatric populations.
• To emphasize the requirement for improved diagnostic methods and thresholds.

Main Methods:

• Review of existing diagnostic modalities for dynamic airway assessment (bronchoscopy, CT, MRI, etc.).
• Discussion of limitations including reliability, intubation needs, radiation, and contrast administration.
• Critique of diagnostic elicitation methods, such as forced expiratory maneuvers and radiographic interpretation.

Main Results:

• Paucity of data on normal central airway collapse across diverse pediatric demographics and health statuses.
• Existing dynamic airway assessment methods have significant limitations.
• Radiographic findings do not always correlate with physiological significance.

Conclusions:

• Current criteria for diagnosing tracheobronchomalacia are poorly validated.
• Larger patient studies are necessary to define pathological airway collapse thresholds.
• More reliable and validated diagnostic standards are required for tracheobronchomalacia.