Tracheal cornage

Specialty: Respiratory.

• low-pitched tracheal stridor
• noisy breathing due to tracheal stenosis

Why it occurs

• Organic tracheal stenosis secondary to previous prolonged endotracheal intubation or tracheostomy (narrowing of the tracheal lumen due to scar or granulomatous tissue that generates a harsh, harsh noise, audible at a distance, mainly inspiratory, called cornage)
• Extrinsic tracheal compression due to giant intrathoracic multinodular goiter or invasive thyroid cancer
• Primary tracheal cancer (adenoid cystic or squamous cell carcinoma of the trachea)
• Severe adult tracheomalacia (collapse of the tracheal cartilages during expiration or inspiration depending on location)
• Relapsing polychondritis (autoimmune disease that destroys the cartilage of the trachea and larynx).

Initial workup

Computed tomography (CT) of the neck and chest with three-dimensional virtual reconstruction of the trachea and bronchial tree; Flexible and rigid bronchoscopy (essential to dynamically evaluate the diameter of the tracheal lumen, the consistency of the cartilaginous rings and the presence of masses); Spirometry (shows a characteristic plateau in both the inspiratory and expiratory branches of the flow-volume curve).

Standard management

• Heliox inhalation — helium-oxygen mixture, to reduce the work of breathing while planning the mechanical intervention
• Dexamethasone — 4-8 mg intravenously every 8 hours to reduce inflammatory edema of the tracheal mucosa
• Colchicine (0.5 mg orally every 12 hours if the cause is active relapsing polychondritis).