Question

A 3-month-old male infant presents with history of noisy breathing since birth; the noise is gradually increasing. There is no history of fever, cough, or running nose. Physical examination reveals a low-pitched, inspiratory wheeze; it is more prominent over the central airways and loudest over the trachea. Wheezing increases during crying, feeding, and when the infant is laid in supine position. There is no cyanosis, subcostal or intercostal retraction, or hoarseness of voice. Wheezing has not shown any response to bronchodilators.

1. Bronchiolitis
2. Congenital subglottic stenosis
3. Tracheomalacia
4. Tracheoesophageal fistula
5. Vocal cord paralysis

Answer 1

The described symptoms of noisy, low-pitched inspiratory breathing that worsens with stressors, lack of response to bronchodilators, and absence of infection suggest a diagnosis of tracheomalacia.

Step-by-step explanation:

The presentation of noisy breathing since birth, which is low-pitched, inspiratory, and increases with crying or feeding without any signs of infection such as fever or runny nose, seems most consistent with a diagnosis of tracheomalacia. Tracheomalacia is a condition where the trachea (windpipe) has weak cartilage that cannot stay open during breathing, leading to collapse and the described wheezing. The lack of response to bronchodilators and the absence of associated symptoms like cough or hoarseness further supports this diagnosis over bronchiolitis, which is typically associated with an infection and would likely present with fever and a cough. It is unlikely to be a tracheoesophageal fistula as there is no mention of symptoms such as pain with swallowing or cough that typically accompany this condition. Additionally, congenital subglottic stenosis and vocal cord paralysis would be expected to also cause hoarseness, which is not present in this case.