Assessment Clinical Findings

The diagnosis of congenital tracheal stenosis and other obstructive anomalies is based on a high degree of suspicion in infants and children with respiratory distress. Inspiratory and/or expiratory stridor may be present, accompanied by retraction. Recurrent or persistent cough and exercise intolerance occur. There may be a history of respiratory difficulties of lesser intensity since birth, or shortly after birth, or of repeated and stubborn respiratory infections. Strangely, dyspnea may be episodic. Cyanosis and apneic episodes may occur. In some cases, difficulty in intubation had led to the diagnosis. Late manifestations of congenital stenosis may represent the child's respiratory demands outpacing the ventilation permitted by the stenotic airway. Only then may a clinical history be retrospectively traced to a much earlier time. Other obstructive lesions are manifest in similar ways.

The clinical presentation of congenital TEF is described in Chapter 12, "Acquired Tracheoesophageal and Bronchoesophageal Fistula." Caution about delayed manifestation of small congenital H-type tra-cheoesophageal fistulae and bronchoesophageal fistulae must be repeated.

Acquired stenosis due to intubation for ventilation is signaled by shortness of breath on exertion and stridor in the wake of a history of intubation, usually for respiratory support, with or without tracheosto-my. Children diagnosed with "asthma," who fail to respond to treatment, must be suspected of an organic airway lesion. If the child has been previously ventilated, the working diagnosis should be airway stenosis, until proved otherwise.

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