Tracheal Disorders

Trachea, commonly known as a “wind pipe,” is the only part of the body that allows air to pass to the lungs. The trachea is a tube whose size varies depending on the size of the person. The diameter can be roughly as wide as a dime in women and as big as a quarter in men.

Causes

Most of the following causes lead to a narrowing of the trachea, resulting in shortness of breath. Attempts to heal some injuries may lead to scarring and narrowing, which if severe, will cause symptoms to develop. 

Tumors blocking any part of trachea

  • Tumor or mass in the trachea
  • Tumor or mass from an adjacent organ that grows into or pushes on the trachea

Stenosis (narrowing)

  • Scar from prior surgery on or near the trachea 
  • Scar from having a breathing tube (being intubated)
  • Idiopathic (no clear reason) tracheal stenosis 
  • Tracheobronchomalacia, abnormal and severe narrowing (or collapse) of the trachea with breathing
  • Congenital (diagnosed in early childhood)

Fistula (incorrect connection between two organs)

  • Usually from a large tumor growing and invading several organs (e.g., trachea, esophagus, vessels)
  • Caused by prior surgery or radiation, which either involved or was performed near the trachea

Trauma 

  • Typically affects part of the trachea in the neck
  • Injury to the neck by hanging, being hit or getting stabbed 
  • Complication of surgery near the trachea, which leads to injury

Inhalation

  • Very hot air or smoke
  • Foreign objects (e.g., food, small toy, tooth)

Symptoms

These symptoms are related to breathing and usually due to blockage. All symptoms start off mild and slowly progress. It is very common for people to misinterpret symptoms as asthma and try treatments that do not work. Progressive symptoms, despite treatment, will eventually lead to a correct diagnosis. 

  • Wheezing
  • Noisy breathing 
  • Stridor (high pitched noise during inhalation)
  • Shortness of breath, which gets worse with exertion
  • Cough 
  • Bleeding/coughing up blood
  • In rare cases, pneumonediastinum (air in the middle of the chest)

Diagnosing Tracheal Disorders

Medical evaluation consists of multiple approaches combining examination, images and special tests. 


Endoscopy

  • Flexible bronchoscopy uses a small camera to look inside the trachea. This test is very useful because it allows your doctor to look into the trachea, evaluate the size and precise location of any strictures, fistula or tumors. During bronchoscopy, your doctor can take a biopsy (small tissue sample) or dilate your trachea to help alleviate symptoms.  
  • Rigid bronchoscopy uses a larger camera placed through a rigid breathing tube to look into the trachea and deliver treatments, which cannot be done during flexible bronchoscopy.
  • Upper endoscopy is similar to bronchoscopy and uses a camera to look into the esophagus. This test is performed when a fistula is suspected. 

Imaging

  • Plain X-rays are typically not detailed enough.
  • CT scan of chest or neck provides additional information about location of a problem area and how it relates to other organs. Scans can help doctors plan for surgery or other treatments.

Treatments

Treatments focus on determining the best method to “open up” the trachea and establish easier breathing (or stop bleeding). Depending on the situation, multiple options are used.

  • Surgery can remove a portion of the trachea and bring the edges together to close the gap. Surgery can be performed for strictures and tumors, but there is a limit to how much of the trachea can be removed successfully. Consult a surgeon when determining whether surgery will deliver good results.
  • Bronchoscopy, in combination with multiple instruments (dilation, coring, laser, cryotherapy), allows for examination, diagnosis and removal of tumors or other objects that were “inhaled” into the trachea. 
  • A stent, a plastic or metal tube, is placed into the trachea (during bronchoscopy) to close a fistula or to push the tumor/mass away and re-open the trachea.  
  • Laser ablation uses a special energy beam directed at a tumor to “vaporize” it. Done during bronchoscopy, this procedure re-opens the part of the trachea blocked by the tumor. 
  • Cryotherapy uses a special device that freezes tissue to remove it. This procedure is also performed during bronchoscopy and re-opens the trachea.