<aside>
Tracheal stenosis refers to narrowing of the tracheal lumen, which may be congenital or acquired, leading to variable respiratory obstruction. It can involve the cervical or intrathoracic trachea, and presents with stridor, dyspnea, or recurrent respiratory infections.
</aside>
https://www.youtube.com/watch?v=u9O271Y2GJM
| Type | Description |
|---|---|
| Congenital | Due to complete tracheal rings or other embryologic anomalies |
| Acquired | Most commonly due to prolonged intubation, trauma, or infection |
| Fixed vs Dynamic | Fixed stenosis causes constant narrowing; dynamic (e.g., tracheomalacia) collapses with respiration |
| Segmental vs long-segment | Localized (e.g., post-intubation) or diffuse (e.g., complete rings) |
Spectrum of postintubation lesions: (A) Cuff stenosis from the cuff of an endotracheal or tracheostomy tube. (B) Cuff stenosis from tracheostomy tube in conjunction with a stenosis at the level of the tracheal stoma and an intervening segment of malacic airway. (C) Laryngotracheal stenosis induced by a tracheostomy tube placed too high in the trachea. A cricothyroidostomy tube or a shallow endotracheal intubation with an overinflated cuff can create a similar lesion.
Wain JC. Postintubation tracheal stenosis. Seminars in Thoracic and Cardiovascular Surgery. 2009;21(3):284-289. doi:10.1053/j.semtcvs.2009.08.001
Acquired Causes
| Etiology | Comments |
|---|---|
| Prolonged intubation | Most common cause in adults and neonates |
| Tracheostomy-related injury | Localized granulation and fibrosis |
| Trauma | Blunt or penetrating airway injury |
| Infections | Tuberculosis, diphtheria, papillomatosis |
| Autoimmune diseases | Wegener (GPA), relapsing polychondritis, sarcoidosis |
| Radiation fibrosis | Post-oncologic therapy-related narrowing |
| Benign/malignant tumors | External compression or intraluminal obstruction |
https://www.youtube.com/watch?v=eumQDuFpFV4
| Symptoms | Comments |
|---|---|
| Stridor | Expiratory (intrathoracic), inspiratory (extrathoracic) |
| Dyspnea, cough | Especially on exertion or during infection |
| Recurrent pneumonia | Due to airway obstruction or poor clearance |
| Voice change, wheezing | May mimic asthma |
| Failure to extubate | In post-ICU patients |
Idiopathic Subglottic Stenosis in a 55-year-old female. Note concentric web-like nature of the lesion.
Aravena, C., Almeida, F. A., Mukhopadhyay, S., Ghosh, S., Lorenz, R. R., Murthy, S. C., & Mehta, A. C. (2020). Idiopathic subglottic stenosis: a review. Journal of thoracic disease, 12(3), 1100–1111. https://doi.org/10.21037/jtd.2019.11.43