Pediatric Radiology

, Volume 40, Issue 5, pp 674–680 | Cite as

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

  • Kieran McHugh
  • Asim Afaq
  • Nigel Broderick
  • Hany O. Gabra
  • Derek J. Roebuck
  • Martin J. Elliott
Original Article



Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery.


To report a series of five infants who developed tracheomegaly following FETO.

Materials and methods

Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres.


Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition.


There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks’ gestation) predisposes to this condition.


Congenital diaphragmatic hernia Tracheal occlusion Tracheomegaly Fetus Infant Fetal endoscopic balloon Tracheomalacia 



We are particularly grateful to Professor Kypros Nicolaides for furnishing much of the antenatal detail of the children and for the information regarding FETO. We are also grateful to innumerable paediatricians in Nottingham and Leeds for allowing us to report two of their patients. We are also grateful to the other members of the tracheal team at Great Ormond Street Hospital for Children, London, for their assistance with these difficult cases. These other team members include Ben Hartley, Colin Wallis, Mike Broadhead, Quen Mok, Alex Barnacle, Clare McLaren, Catherine Dunne, Clair Noctor and Caroline Doyle.


  1. 1.
    Torfs CP, Curry CJ, Bateson TF et al (1992) A population-based study of congenital diaphragmatic hernia. Teratology 46:555–565CrossRefPubMedGoogle Scholar
  2. 2.
    Saura L, Castanon J, Prat A et al (2007) Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia. Eur J Pediatr Surg 17:404–407CrossRefPubMedGoogle Scholar
  3. 3.
    West SD, Wilson JM (2005) Follow up of infants with congenital diaphragmatic hernia. Semin Perinatol 29:129–133CrossRefPubMedGoogle Scholar
  4. 4.
    Cortes RA, Keller RL, Townsend T et al (2005) Survival of severe congenital diaphragmatic hernia has morbid consequences. J Pediatr Surg 40:36–46CrossRefPubMedGoogle Scholar
  5. 5.
    Deprest J, Jani J, Gratacos E et al (2005) Fetal intervention for congenital diaphragmatic hernia: the European experience. Semin Perinatol 29:94–103CrossRefPubMedGoogle Scholar
  6. 6.
    Harrison MR, Adzick NS, Bullard KM et al (1997) Correction of congenital diaphragmatic hernia in utero. VII: a prospective trial. J Pediatr Surg 32:1637–1642CrossRefPubMedGoogle Scholar
  7. 7.
    Laberge JM, Flageole H (2007) Fetal tracheal occlusion for the treatment of congenital diaphragmatic hernia. World J Surg 31:1577–1586CrossRefPubMedGoogle Scholar
  8. 8.
    Flageole H, Evrard V, Piedboef B et al (1998) The plug-unplug sequence: an important step to achieve type II pneumocyte maturation in the fetal lamb model. J Pediatr Surg 33:299–303CrossRefPubMedGoogle Scholar
  9. 9.
    Harrison MR, Keller RL, Hawgood SB et al (2003) A randomised trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Eng J Med 349:1916–1924CrossRefGoogle Scholar
  10. 10.
    Chiba T, Albanese CT, Farmer DL et al (2000) Balloon tracheal occlusion for congenital diaphragmatic hernia: experimental studies. J Pediatr Surg 35:1566–1570CrossRefPubMedGoogle Scholar
  11. 11.
    Deprest J, Evrard V, Verbeken EK et al (2000) Tracheal side effects of endoscopic balloon tracheal occlusion in the fetal lamb model. Eur J Obstet Gynecol Reprod Biol 92:119–126CrossRefPubMedGoogle Scholar
  12. 12.
    Doné E, Gucciardo L, Van Mieghem T et al (2008) Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia. Prenat Diagn 28:581–591CrossRefPubMedGoogle Scholar
  13. 13.
    Adam A, Dixon AK (eds) (2008) Grainger and Allison’s diagnostic radiology: A textbook of medical imaging, 5th edn. Elsevier Churchill Livingstone, Philadelphia, p 420Google Scholar
  14. 14.
    Menon B, Aggarwal B, Iqbal A (2008) Mounier-Kuhn syndrome: report of 8 cases of tracheobronchomegaly with associated complications. South Med J 101:83–87PubMedGoogle Scholar
  15. 15.
    Boiselle PM, Feller-Kopman D, Ashiku S et al (2003) Tracheobronchomalacia: evolving role of dynamic multislice helical CT. Radiol Clin North Am 41:627–636CrossRefPubMedGoogle Scholar
  16. 16.
    Harrison MR, Sydorak RM, Farrell JA et al (2003) Fetoscopic temporary tracheal occlusion for congenital diaphragmatic hernia: prelude to a randomized, controlled trial. J Pediatr Surg 38:1012–1020CrossRefPubMedGoogle Scholar
  17. 17.
    Randomized control trial of fetoscopic endoluminal tracheal occlusion with a balloon versus expectant management during pregnancy in fetuses with left sided congenital diaphragmatic hernia and moderate pulmonary hypoplasia. University Hospital, Gasthuisberg (2008) Identifier: NCT00763737.
  18. 18.
    Deprest J, Gratacos E, Nicolaides KH et al (2004) Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol 24:121–126CrossRefPubMedGoogle Scholar
  19. 19.
    Cannie MM, Jani JC, De Keyzer F et al (2009) Evidence and patterns in lung response after fetal tracheal occlusion: clinical controlled study. Radiology 252:526–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kieran McHugh
    • 1
  • Asim Afaq
    • 1
  • Nigel Broderick
    • 2
  • Hany O. Gabra
    • 3
  • Derek J. Roebuck
    • 1
  • Martin J. Elliott
    • 3
  1. 1.Radiology DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
  2. 2.Radiology DepartmentNottingham University HospitalsNottinghamUK
  3. 3.Department of Cardiothoracic SurgeryGreat Ormond Street Hospital for ChildrenLondonUK

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