The trachea, known as the airway or windpipe, is a tube that starts under the larynx (voice box) and runs behind the breastbone. It then divides into two smaller tubes, (bronchi) which lead to the lungs. When breathing, a normal trachea widens and lengthens with each breath. Inflammation can cause scarring and narrowing of the trachea, while birth defects or injury can cause the trachea to become soft and floppy. Tumors can also cause blockage of the trachea or the main bronchi. All of these conditions can severely affect your breathing.
Board-certified thoracic surgeons and pulmonologists at the Brigham and Women's Hospital Lung Center provide comprehensive, specialized care for patients experiencing tracheal disorders. Their expertise and collaboration with other specialists throughout BWH provide patients with a highly informed diagnosis and a cohesive treatment plan. Should surgery or a procedure be required, our surgeons and interventional pulmonologists are experts in tracheal resection and reconstruction surgery and collaborate with specialized otolaryngologists to ensure the best outcomes.
There are two main types of tracheal disorders:
Tracheal stenosis is a narrowing of the trachea, or “windpipe,” that prevents air from fully reaching the lungs. The effects of this narrowing can range in severity from mild to more severe. In the most severe cases, the patient may be dependent on a tracheotomy tube to breathe.
Tracheomalacia is a condition characterized by cartilage in the walls of the trachea that has broken down, semi-causing weakness or floppiness in the windpipe. The trachea should be rigid for normal breathing. Infants can be born with tracheomalacia, but adults can also acquire it in later life.
Tracheal tumors, while rare, can cause narrowing of the windpipe which prevents air from fully reaching the lungs. They can also cause coughing of blood.
Types of tumors include:
Benign: pleomorphic adenoma, squamous cell papilloma, chondroma, granular cell tumor, glomus tumor, neurofibroma
Malignant: adenoid cystic carcinoma, squamous cell carcinoma, malignant epithelial tumor, carcinoid tumor, mucoepidermoid carcinoma, small cell and non-small cell lung cancer
Other tracheal disorders managed by The Lung Center include tracheo-esophageal fistula, an abnormal connection (fistula) between the esophagus and the trachea, and tracheobronchomalacia, a rare condition that occurs when the airway walls are weak, leading them to narrow or collapse.
The most common cause of tracheal stenosis is intubation, when a patient has had a breathing tube inserted into the trachea for surgery or other medical procedures.
Other causes may include:
Tracheomalacia can have many causes, the most common are:
In addition to a careful physical examination, The Lung Center team may perform the following procedures to determine if your symptoms are caused by tracheal stenosis:
After taking your medical history and performing a careful physical examination, The Lung Center team may perform the following procedures to confirm a diagnosis of tracheal stenosis or tracheomalacia:
Pulmonary ventilation/perfusion scan involves two nuclear scan tests: injection of radioactive albumin into your veins and breathing radioactive gas through a mask to allow a machine to measure circulation (perfusion) and breathing (ventilation).
There are several surgical options to treat tracheal stenosis. Your thoracic surgeon will recommend the best option for you, based on the cause, location and severity of the narrowing. Possible treatments and procedures are:
Often, tracheomalacia can improve without treatment. However, you should be monitored closely if you suffer from frequent respiratory infections. Treatments may include:
In addition to using some of the surgical procedures listed above, your physician may treat your tumor using some of the following therapies:
When you become a patient of The Lung Center you will meet with many members of the team who will carefully review your medical history and conduct a thorough diagnostic evaluation. You will receive a recommendation for a therapy tailored just for you, based on your specific disorder and other factors, as well as comprehensive monitoring.
Patients with tracheal disorders benefit from the wide range of expertise at The Lung Center. Collaboration between thoracic surgeons, pulmonologists, otolaryngologists, radiologists, respiratory and speech therapists and other specialists and other specialists ensures comprehensive evaluation and effective treatment. If your medical team discovers an underlying illness or concern, you will be referred to a BWH physician for an expert evaluation.
Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon, interventional pulmonologist or interventional radiologist who is an expert in tracheal disorders, in collaboration with the treatment team that including nurses and physician assistants who specialize in caring for patients with tracheal disorders. Your surgeon will also collaborate with pulmonologists and otolaryngologists to tailor a treatment plan for you. Our specialized care team has some of the best results in the country.
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