Tracheal Agenesis

Tracheal agenesis (TA) is a rare congenital malformation in which the trachea may be completely absent (agenesis), or partially in place but underdeveloped (atresia). In both cases, proximal-distal communication between the larynx and the alveoli of the lungs is lacking.

Epidemiology

The prevalence at birth is approximately 1 in 50 000. There is a male predominance and an association with prematurity and polyhydramnios.

Clinical description

Associated congenital malformations are present in 90% of cases, most frequently affecting the cardiovascular or gastro-intestinal systems and the genito-urinary tract, thus overlapping with the much commoner condition, VATER association.

Etiology

No risk factor for the occurrence of this malformation has ever been suggested.

Diagnostic methods

Tracheal agenesis should be suspected in any neonate with a history of hydramnios, respiratory distress, cyanosis and no audible cry, and in those in whom tracheal intubation proves impossible. The diagnosis of TA is confirmed by laryngoscopy and a helical computerized tomography (CT) scan of the airway. The diagnosis has been established antemortem in only a few cases.

Management and treatment

There is no long-term surgical solution because no suitable material for a tracheal prosthesis is available at present. Research into tissue engineering might lead to possibilities for definitive surgical repair of tracheal agenesis or atresia; however, until curative repair becomes possible, prolonged ventilation via the oesophageal tube does not seem to be worthwhile.

Prognosis

This malformation is usually fatal in newborns; however, one infant, who had tracheal agenesis with a bronchoesophageal fistula, was managed successfully. At 3 years of age, esophageal reconstruction was performed with a colonic interposition graft. The patient was thriving and developing normally at 4 years of age.