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

Abstract

Background

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.

Objective

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.

Results

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.

Conclusion

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.

Keywords

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

Notes

Acknowledgements

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.

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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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