Below is a concise but complete paediatrics reference for airway malformations and foreign body airway obstruction as requested (no images).
Airway Malformations and Foreign Body in Airway (Paediatrics)
1. Laryngomalacia
Definition
Laryngomalacia is the most common congenital laryngeal anomaly, characterized by collapse of supraglottic structures during inspiration, leading to stridor in infants.
Pathophysiology
Immature laryngeal cartilage and abnormal neuromuscular tone cause the epiglottis and arytenoid structures to collapse inward during inspiration, producing airway obstruction and inspiratory stridor.
Causes / Risk Factors
- Congenital structural weakness
- Neuromuscular immaturity
- Associated conditions:
* Gastroesophageal reflux disease (GERD)
* Neurological disorders
* Prematurity
Clinical Features
- Inspiratory stridor (appears at 2–4 weeks of age)
- Worse when:
* Supine
* Feeding
* Crying
- Improves when prone
- Feeding difficulty
- Failure to thrive (severe cases)
- Apnea or cyanosis (rare)
Investigations / Diagnosis
- Flexible laryngoscopy (gold standard)
* Omega-shaped epiglottis
* Collapse of arytenoids
- Pulse oximetry
- Sleep study if severe
- Evaluate for GERD
Differential Diagnosis
- Vocal cord paralysis
- Subglottic stenosis
- Tracheomalacia
- Vascular rings
- Foreign body aspiration
Management
Conservative
Most cases resolve by 12–18 months.
Non-pharmacologic:
- Upright feeding
- Thickened feeds
- GERD management
Pharmacologic
Omeprazole
Indication
GERD associated with laryngomalacia
Mechanism
Proton pump inhibitor → blocks gastric acid secretion
Dose
Infants: 0.5–1 mg/kg/day
Adverse Effects
- Diarrhea
- Headache
- Vitamin B12 deficiency (long term)
Monitoring
Symptoms and weight gain
Surgical
Supraglottoplasty
Indications:
- Severe airway obstruction
- Failure to thrive
- Apnea
- Hypoxia
2. Congenital Subglottic Stenosis
Definition
Narrowing of the subglottic airway below the vocal cords, either congenital or acquired.
Pathophysiology
Failure of normal airway recanalization results in reduced airway diameter, leading to airflow obstruction.
Clinical Features
- Biphasic stridor
- Respiratory distress
- Recurrent croup
- Difficulty breathing
Diagnosis
- Rigid bronchoscopy (gold standard)
- CT airway
- Laryngoscopy
Severity Classification
Cotton-Myer grading:
| Grade | Airway obstruction |
| ----- | ------------------ |
| I | <50% |
| II | 51–70% |
| III | 71–99% |
| IV | Complete |
Management
Mild
- Observation
- Treat infections
Moderate
- Endoscopic dilation
- Steroid injection
Severe
- Laryngotracheal reconstruction
- Tracheostomy
3. Congenital Lobar Emphysema (CLE)
Definition
Overinflation of a pulmonary lobe due to air trapping from bronchial cartilage weakness.
Most Common Lobes
- Left upper lobe
- Right middle lobe
Pathophysiology
Air enters during inspiration but cannot exit during expiration → progressive hyperinflation.
Clinical Features
- Neonatal respiratory distress
- Tachypnea
- Cyanosis
- Hyperresonant chest
- Mediastinal shift
Diagnosis
Chest X-ray:
- Hyperlucent lobe
- Mediastinal shift
CT scan
- Confirms diagnosis
Differential Diagnosis
- Pneumothorax
- CPAM
- Pulmonary sequestration
Management
Mild cases
- Observation
Severe cases
- Lobectomy
4. Congenital Pulmonary Adenomatoid Malformation (CPAM)
Previously called Congenital Cystic Adenomatoid Malformation (CCAM).
Definition
Developmental lung lesion characterized by abnormal cystic lung tissue replacing normal alveoli.
Types (Stocker classification simplified)
| Type | Description |
| -------- | -------------------- |
| Type I | Large cysts |
| Type II | Multiple small cysts |
| Type III | Solid mass |
Clinical Features
- Respiratory distress in neonates
- Recurrent pneumonia
- Asymptomatic (prenatal diagnosis)
Diagnosis
Prenatal
- Fetal ultrasound
Postnatal
- Chest CT
Complications
- Infection
- Pneumothorax
- Malignancy risk (rare)
Management
- Surgical resection (lobectomy)
- Even if asymptomatic (often recommended)
5. Pulmonary Sequestration
Definition
A mass of nonfunctional lung tissue that does not connect to the tracheobronchial tree and receives blood supply from the systemic circulation (usually aorta).
Types
Intralobar
- Within normal lung
- Shares pleura
Extralobar
- Separate pleura
- Often diagnosed in infancy
Pathophysiology
Abnormal lung bud development leads to isolated lung tissue with systemic arterial supply.
Clinical Features
- Recurrent pneumonia
- Respiratory distress
- Chronic cough
Diagnosis
CT angiography
Shows abnormal systemic artery from aorta
Management
- Surgical resection
- Endovascular embolization (selected cases)
6. Foreign Body in the Airway (Paediatrics)
Definition
Inhalation of a foreign object causing partial or complete airway obstruction.
Common Objects
- Peanuts
- Seeds
- Toys
- Coins
- Food particles
Risk Age
1–3 years
Pathophysiology
Object lodges in airway causing:
- Obstruction
- Air trapping
- Atelectasis
- Infection
Most common location
Right main bronchus
Clinical Features
Acute phase
- Sudden choking
- Cough
- Stridor
- Wheezing
Later phase
- Persistent cough
- Recurrent pneumonia
- Unilateral wheeze
Diagnosis
Chest X-ray
- Air trapping
- Atelectasis
- Mediastinal shift
Definitive diagnosis
Rigid bronchoscopy
Differential Diagnosis
- Asthma
- Bronchiolitis
- Pneumonia
- Croup
Emergency Management
If Complete Airway Obstruction
Infant (<1 year)
- 5 back blows
- 5 chest thrusts
Child (>1 year)
- Heimlich maneuver
Definitive Treatment
Rigid Bronchoscopy (Gold Standard)
Performed under general anesthesia to remove foreign body.
Complications if untreated:
- Pneumonia
- Lung abscess
- Bronchiectasis
- Death
Key Exam Points (High Yield)
- Most common congenital laryngeal anomaly: Laryngomalacia
- Most common congenital lung lesion: CPAM
- Most common site for airway foreign body: Right main bronchus
- Gold standard for diagnosis and treatment of foreign body: Rigid bronchoscopy
- Congenital lung tissue with systemic blood supply: Pulmonary sequestration
- Hyperinflated lung lobe in neonate: Congenital lobar emphysema
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