Tracheomalacia - acquired
Secondary tracheomalaciaAcquired tracheomalacia is a weakness and floppiness of the walls of the windpipe (trachea, or airway). It develops after birth.
Congenital tracheomalacia is a related topic.
Congenital tracheomalacia
Congenital tracheomalacia is weakness and floppiness of the walls of the windpipe (trachea). Congenital means it is present at birth. Acquired trac...
Causes
Acquired tracheomalacia is very uncommon at any age. It occurs when normal cartilage in the wall of the windpipe begins to break down.
This form of tracheomalacia may result:
- When large blood vessels put pressure on the airway
- As a complication after surgery to repair birth defects in the windpipe and esophagus (the tube that carries food from the mouth to the stomach)
- After having a breathing tube or trachea tube (tracheostomy) for a long time
Symptoms
Symptoms of tracheomalacia include:
- Breathing problems that get worse with coughing, crying, or upper respiratory infections, such as a cold
- Breathing noises that may change when body position changes, and improve during sleep
- High-pitched breathing
- Rattling, noisy breaths
Exams and Tests
A physical exam confirms the symptoms. A chest x-ray may show narrowing of the trachea when breathing out. Even if the x-ray is normal, it is needed to check for other problems.
A procedure called a laryngoscopy is used to diagnose the condition. This procedure allows an otolaryngologist (ear, nose, and throat doctor, or ENT) to see the structure of the airway and determine how severe the problem is.
Other tests may include:
- Airway fluoroscopy
- Barium swallow
- Bronchoscopy
Bronchoscopy
Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.
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CT scan
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
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Lung function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
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Magnetic resonance imaging
A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (...
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Treatment
The condition may improve without treatment. However, people with tracheomalacia must be monitored closely when they have respiratory infections.
Adults with breathing problems may need continuous positive airway pressure (CPAP). Rarely, surgery is needed. A hollow tube called a stent may be placed to hold the airway open.
Continuous positive airway pressure
Positive airway pressure (PAP) treatment uses a machine to pump air under pressure into the airway of the lungs. This helps keep the windpipe open d...
Stent
A stent is a tiny tube placed into a hollow structure in your body. This structure can be an artery, a vein, or another structure, such as the tube ...
Possible Complications
Aspiration pneumonia (a lung infection) can occur from breathing in food or saliva.
Aspiration pneumonia
Pneumonia is inflammation (swelling) and infection of the lungs or large airways. Aspiration pneumonia occurs when food or liquid is breathed into th...
Adults who develop tracheomalacia after being on a breathing machine often have serious lung problems.
When to Contact a Medical Professional
Contact your health care provider if you or your child breathes in an abnormal way. Tracheomalacia can become an urgent or emergency condition.
References
Finder JD. Bronchomalacia and tracheomalacia. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 437.
Green GE, Ohye RG. Diagnosis and management of tracheal anomalies and tracheal stenosis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 210.
Little BP. Tracheal diseases. In: Walker CM, Chung JH, eds. Muller's Imaging of the Chest. 2nd ed. Philadelphia, PA: Elsevier; 2019:chap 56.
Respiratory system overview - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system overview
illustration
Review Date: 4/5/2025
Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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