Congenital high airway obstruction syndrome due to complete tracheal agenesis: An accident of nature with clues for tracheal development and lessons in management

Sachin S. Vaikunth, Lee M. Morris, William Polzin, William Gottliebson, Foong Yen Lim, Beth Kline-Faith, Timothy M. Crombleholme

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Congenital high airway obstruction syndrome (CHAOS) is a life-threatening condition characterized by complete blockage of the fetal airways associated with hydrops. We present a case of CHAOS due to the rare cause of complete tracheal agenesis. The ex utero intrapartum therapy (EXIT) strategy was employed to allow for neck and mediastinal exploration. Thymectomy allowed dissection to the level of the carina demonstrating the confluence of dilated mainstem bronchi but no trachea and no connection to the esophagus. A 2.5 endotracheal tube was inserted into the right mainstem bronchus and secured to the left clavicle. At 3 months of age, the infant succumbed to sepsis from Enterobacter mediastinitis due to friction between the tracheostomy tube and the nasogastric tube resulting in erosion of the esophagus. Complete tracheal agenesis, as seen in this case, is consistent with the failure of normal tracheal elongation as suggested by newer theories of foregut development. This case illustrates the most severe form of tracheal atresia causing CHAOS ever salvaged by the EXIT procedure at birth. The subsequent postnatal course highlights the need for early tracheal replacement in this particularly challenging form of CHAOS.

Original languageEnglish (US)
Pages (from-to)93-97
Number of pages5
JournalFetal Diagnosis and Therapy
Volume26
Issue number2
DOIs
StatePublished - Oct 2009

Keywords

  • Congenital high airway obstruction syndrome
  • Ex utero intrapartum therapy
  • Tracheal agenesis

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging

Fingerprint Dive into the research topics of 'Congenital high airway obstruction syndrome due to complete tracheal agenesis: An accident of nature with clues for tracheal development and lessons in management'. Together they form a unique fingerprint.

Cite this