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Tracheal Tugging

Published:December 04, 2019DOI:https://doi.org/10.1016/j.jpeds.2019.10.080
      A 1-month-old female patient was referred to our hospital with a history of noisy breathing and poor weight gain. The noisy breathing worsened when the patient was crying or feeding, and feeding was sometimes difficult due to respiratory distress. The patient was delivered vaginally at term with a birth weight of 2.3 kg. On examination, her pulse rate, respiratory rate, body temperature, and oxygen saturation were 158 beats per minute, 44 breaths per minute, 37.2°C, and 99% on room air, respectively. Inspiratory stridor was present in the supine position. During inspiration, suprasternal in-drawing, tracheal tugging, was observed (Figure and Video [available at www.jpeds.com]). The tracheal tugging worsened during fits of crying. Flexible fiberoptic laryngoscopy was performed by a pulmonologist for further evaluation and demonstrated a roughly omega-shaped epiglottis. Laryngomalacia was diagnosed based on the clinical and laryngoscopic findings.
      Figure thumbnail gr1
      FigureSuprasternal in-drawing corresponding with stridor, resulting from downward traction of the trachea towards the thoracic cavity (tracheal tugging).

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