Rare Cause for Common Symptoms; Adult Tracheomalacia- A Case Report

Tracheomalacia characterized by weakness of the tracheal wall is encountered uncommonly in adult clinical practice. However, many cases are under-recognized. Here we report a case of tracheomalacia in an adult, managed as poorly controlled asthma for a long duration prior to diagnosis. A 44 year old male with a past history of mild intermittent bronchial asthma, diabetes mellitus and hypertension presented with cough and shortens of breath for 2 years duration with significant progressive symptoms associated with a change in voice over 5 months. Physical examination was unremarkable. Chest radiograph and pulmonary functions were within normal limits. However, high resolutions computerized tomography (HRCT) revealed crescent shape collapse of the trachea. Near complete obliteration of tracheal lumen due to approximation of anterior and posterior tracheal walls was noted in bronchoscopy, confirming the diagnosis of tracheomalacia. He underwent successful implantation of endotracheal silicon stent with significant resolution of symptoms. In conclusion, clinical features of tracheomalacia are non-specific. Therefore it is likely to be underrecognized and managed as for other common respiratory pathologies. The high degree of suspicion on this uncommon condition is required to avoid misdiagnosis.