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Respiratory Disorders (Expert Forum)
Tracheomalacia in 9 yr old?
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Tracheomalacia in 9 yr old?
by kass, Feb 02, 2003 12:00AM
I am the mom of a 9 1/2 year old boy w/ strongly suspected
Tracheobroncomalacia seeking thoughts on test results thus far.
Dx'd Mitochondrial Encephalopathy 02/01 at Cleveland Clinic, neurologically affected, progressive. Croup 4 times as infant and age 4, some GI issues, mild low muscle tone shoulder/girdle. Otherwise healthy. Noted 06/02 that he was losing muscle mass in arms and hands,regression in handwriting, confirmed by mito specialist 10/02.
08/02 started with pain and shortness of breath w/ mild exercise. No wheezing/cooghing. 12/02 exercise testing and Echo normal, PFT's very abnormal w/ severely decreased FEV1 with exercise. Functions worse after bronchodilator. Started Foradil with no response.
01/30 pulmonologist repeated PFT's, report reads: "Force vital capacity was 106% predicted and his FEV1 was 81% predicted. This gave him an FEV1 to FVC ratio .70. This shows evidence of mild airflow obstruction. What is interesting is that his loops are very flattened both inspiratory as well as expiratory. After giving him a bronchodilator, he had a 19% fall in FEV1. This makes me concerned that he may have a component of tracheomalacia and the bronchodilators may be decreasing his airway tone causing further obstruction. On physical exam, he does have a prolonged
expiratory phase and baseline." Plan: Chest xray to check diaphragm for weakness & bronchoscopy to better evaluate for tracheobronchomalacia.
Pulmonologists feels loss of muscle mass/tone& progression of disease, is affecting the trachea causing the tracheomalacia. Thanks so much for any thoughts.
Tracheobroncomalacia seeking thoughts on test results thus far.
Dx'd Mitochondrial Encephalopathy 02/01 at Cleveland Clinic, neurologically affected, progressive. Croup 4 times as infant and age 4, some GI issues, mild low muscle tone shoulder/girdle. Otherwise healthy. Noted 06/02 that he was losing muscle mass in arms and hands,regression in handwriting, confirmed by mito specialist 10/02.
08/02 started with pain and shortness of breath w/ mild exercise. No wheezing/cooghing. 12/02 exercise testing and Echo normal, PFT's very abnormal w/ severely decreased FEV1 with exercise. Functions worse after bronchodilator. Started Foradil with no response.
01/30 pulmonologist repeated PFT's, report reads: "Force vital capacity was 106% predicted and his FEV1 was 81% predicted. This gave him an FEV1 to FVC ratio .70. This shows evidence of mild airflow obstruction. What is interesting is that his loops are very flattened both inspiratory as well as expiratory. After giving him a bronchodilator, he had a 19% fall in FEV1. This makes me concerned that he may have a component of tracheomalacia and the bronchodilators may be decreasing his airway tone causing further obstruction. On physical exam, he does have a prolonged
expiratory phase and baseline." Plan: Chest xray to check diaphragm for weakness & bronchoscopy to better evaluate for tracheobronchomalacia.
Pulmonologists feels loss of muscle mass/tone& progression of disease, is affecting the trachea causing the tracheomalacia. Thanks so much for any thoughts.
Doctor's Answer
by National Jewish, Feb 04, 2003 12:00AM
, Feb 04, 2003 12:00AM
This is a very complicated case that requires more investigation before suggesting any specifics. The different PFT test results may indicate an inability to perform the test reliably. This may reflect a muscle coordination issue rather than a lung issue. The response to the bronchodilator also may indicate a nonpulmonary effect going on. Further evaluation as is being suggested should help provide more information to help in the diagnosis.
and, then
www.cforyourself.com
May God bless your boy with health.