CONGENITAL ANOMALIES OF

RESPIRATORY TRACT

DR.SEHAR ZAHID
ASSISTANT PROFESSOR
PAEDIATRICS
 LEARNING OBJECTIVES

• To enumerate the anatomical abnormalities of larynx, trachea and diaphragm

• To know the clinical features
• To identify these radiologically
• To describe their management
ANATOMICAL STRUCTURES
 TRACHEAL AND LARYNGEAL
ABNORMALITIES

• Laryngomalacia, Tracheomalacia
• Congenital subglottic stenosis
• Congenital webs and atresia
• Congenital subglottic hemangioma
• Tracheoesophageal fistulas and clefts
 TRACHEAL AGENESIS

• Associated with maternal polyhydramnios

• Presented immediately with severe respiratory distress, absent cry and unable
to intubate
• 3 types
 TRACHEAL STENOSIS

• Presented with stridor at birth

• CT scan, MRI used to identify
• 3 types
• Generalized
• Focal
• Funnel
TRACHEAL STENOSIS
 LARYNGOMALACIA
&TRACHEOMALACIA

• Tracheal softening due to cartilage abnormalities

• Primary congenital immaturity of cartilage
• Secondary normal cartilage undergoes degeneration
• Due to chronic infections cyctic fibrosis, recurrent aspirations and
immunodeficiencies or extrinsic pressures by slings, vascular rings.
• Diagnosed by CT scan, bronchoscopy
 TRACHEOESOPHAGEAL FISTULA

• Associated with esophageal atresia

• Presentation will be choking, coughing at time of feeding
• 5 types
• Imaging should be done to know the exact type
TYPES
RADIOLOGY OF TEF
 LARYNGEAL WEBS AND ATRESIA

• Anterior glottis and subglottis stenosis due to incomplete recanalization of

laryngetracheal tube.
• Associated with other chromosomal and cardiovascular anomalies
• Diagnosed by direct laryngoscopy
• Management only incision and dilation
• Can be diagnosed antenatally.
ENDOSCOPIC VIEW
CONGENITAL DIAPHRAGMATIC
HERNIA
 CONGENITAL DIAPHRAGMATIC
HERNIA

• Communication between abdominal and thoracic cavity with or without

abdominal contents in thorax.
• Rarely traumatic
• Types
• Posterolateral(bochdalek) 90% with (90% left sided)
• Hiatal(esophageal hiatus)
• Para esophageal
• Retrosternal hernia(Morgagni) 2-6 %
CONGENITAL DIAPHRAGMATIC
HERNIA
RADIOLOGY
 DIAPHRAGMATIC HERNIA

• Presented with pulmonary hypoplasia

• Associated with esophageal atresia, omphaloceole, CVS and CNS anomalies
• Clinically
• Diagnosis
• Antenataly 50 % on prenatal Ultrasound
• After birth Chest Xray
• Management
• Early respiratory support and surgery
EVENTRATION OF DIAPHRAGM
 EVENTRATION OF DIAPHRAGM

• Abnormal elevation of thinned diaphragmatic muscle either entire or more

often on anterior aspect of hemi diaphragm
• Associated with congenital heart diseases and chromosomal abnormalities
• Treated with mechanical ventilation and surgical repair
ANY QS