de Mello Ramon Andrade, Magalhães Adriana, Vilas-Boas Abílio José
Internal Medicine Department of São João Hospital, Porto, Portugal.
Sao Paulo Med J. 2012;130(1):61-4. doi: 10.1590/s1516-31802012000100011.
Tracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis.
An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD) and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement.
TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.
气管支气管软化症（TBM）由呼吸系统的结构和功能异常引起。其特征为过度塌陷：气管和主支气管横截面积至少减少50%。在本文中，我们报告了一例罕见的TBM患者，该患者最初因慢性支气管炎加重出现喘鸣和呼吸衰竭。
一名81岁的白种男性因咳嗽、脓性痰、喘鸣和呼吸衰竭入院。他有慢性阻塞性肺疾病（COPD）和矽肺病史，既往吸烟。胸部轴向计算机断层扫描显示气管中三分之一明显塌陷。支气管镜检查显示符合TBM的特征。他接受了无创通气治疗，但效果不佳。随后，通过硬支气管镜置入了一枚杜蒙Y型支架。术后，他临床症状改善后出院。
TBM是致命的，且常常诊断不足。在COPD患者中，喘鸣和呼吸衰竭可能是有用的体征，应提醒医生考虑早期诊断TBM。因此，这些体征对于优化此类患者的治疗和病情发展可能很重要。
