Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:181

Proceedings of Scientific Meeting

Tracheal Agenesis : Report of A Case

SY Lam, KT So

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

Introduction : Tracheal atresia is an extremely rare condition. At birth, the baby will require immediate vigorous resuscitation . In this report, we present an infant with tracheal atresia, and the lessons learned through managing this case.

Report of case : A premature girl was delivered at 33 3/7 week. At birth she was cyanotic, flaccid and heart rate was 60/min. The baby did breathe vigorously but no cry was heard. Endotracheal intubation was attempted but could not advance beyond the vocal cords. The ventilation was then delivered through bag and mask and the baby turned pink and heart rate increased to 120/min. Urgent X-ray showed a gas column in the thorax suggestive of short segment tracheal atresia. Emergency tracheostomy was attempted which failed to find any trachea but only an air-filled esophagus. Patient gradually deteriorated and died Post-mortem examination showed tracheal atresia just below the vocal cord. A blind pouch of trachea was found just above the carina, with a fistula connecting to the lower end of esophagus.

Discussion : Atresia of trachea should be suspected when a newborn is cyanotic at birth, aphonic and the endotracheal tube cannot be advanced beyond the vocal cord. The condition is usually fatal. When a fistula between the airway and the esophagus is present, the oxygenation can be improved transiently by bagging through a mask. This is usually not sufficient to sustain life and death is just postponed . On the other hand, if there is only short segment tracheal atresia, immediate tracheostomy may be life saving, with a definite repair of the trachea at later life. However, one should be cautious not to be misguided by the gas-filled esophagus to reach this diagnosis.


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