🚨#PulmTwitter #pulmboards #IPtwitter
#HPI
🫁persistent dyspnea
🫁multiple admissions for resp failure
🫁syncopal episode but negative w/u
You may be dealing w/ #Tracheobronchomalacia
A topic that I personally find V challenging
Let's try to dissect it in this brief 🧵
#HPI
🫁persistent dyspnea
🫁multiple admissions for resp failure
🫁syncopal episode but negative w/u
You may be dealing w/ #Tracheobronchomalacia
A topic that I personally find V challenging
Let's try to dissect it in this brief 🧵
What do we know about TBM ? @MedTweetorials
📝Underdiagnosed entity
📝Frequently Misdiagnosed
📝No standardized classification
📝Heterogenous Presentation
📝Significant morbidity/QoL implications
📝Only invasive curable options
📝Underdiagnosed entity
📝Frequently Misdiagnosed
📝No standardized classification
📝Heterogenous Presentation
📝Significant morbidity/QoL implications
📝Only invasive curable options
Signs/symptoms ?
Dr Musani's paper has us covered
@AlaEddinSagar @emily_fri @eemoin @EmmGeezee @emcrit
pubmed.ncbi.nlm.nih.gov
Dr Musani's paper has us covered
@AlaEddinSagar @emily_fri @eemoin @EmmGeezee @emcrit
pubmed.ncbi.nlm.nih.gov
common Q = How to Diff TBM vs EDAC
TBM - weakness of the anterior tracheobronchial cartilage wall
EDAC - inward bulging of the atrophic muscular fibers in the posterior airway membrane during exhalation with narrowing of the cross sectional airway lumen
TBM - weakness of the anterior tracheobronchial cartilage wall
EDAC - inward bulging of the atrophic muscular fibers in the posterior airway membrane during exhalation with narrowing of the cross sectional airway lumen
Pro Tip - Can have variable morphological presentations
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
Classification
Slide Courtesy Dr Majid @AAB_IP from @BIDMChealth
- in the past >50% cutoff was used
- data suggests that if we use that cutoff 78% of normal volunteers would meet criteria
- 70% cuttoff is now preferred
@nickmmark @OnePagerICU
Slide Courtesy Dr Majid @AAB_IP from @BIDMChealth
- in the past >50% cutoff was used
- data suggests that if we use that cutoff 78% of normal volunteers would meet criteria
- 70% cuttoff is now preferred
@nickmmark @OnePagerICU
What do we know regarding PFT's and TBM
pubmed.ncbi.nlm.nih.gov
@udit_chaddha @ACM_LTx_Bronch
@dfellerk @DocAbedi @samirashojaee
@WiIP_WomeninIP @wabipconnect @naj_rahman @ahalraiyes
pubmed.ncbi.nlm.nih.gov
@udit_chaddha @ACM_LTx_Bronch
@dfellerk @DocAbedi @samirashojaee
@WiIP_WomeninIP @wabipconnect @naj_rahman @ahalraiyes
Diagnosis ?
🌟🌟Bronchoscopic
🌟🌟Dynamic Chest CT
🌟pls tell your radiologist your clinical concern when you order and mention expiratory views🌟
🌟🌟Bronchoscopic
🌟🌟Dynamic Chest CT
🌟pls tell your radiologist your clinical concern when you order and mention expiratory views🌟
Management ?
⚽️Depends if Asympt VS Sympt
⚽️Multidisciplinary Management
⚽️Aggressive Risk factor/trigger Reduction
⚽️Tx Comorbid conditions
⚽️Depends if Asympt VS Sympt
⚽️Multidisciplinary Management
⚽️Aggressive Risk factor/trigger Reduction
⚽️Tx Comorbid conditions
What do we know regarding silicone stent data
🏈Landmark study
🏈77% reported improvement
🏈R side - What subjective/objective parameters were checked
🏈Bottom - AE related to stent placement
🏈Landmark study
🏈77% reported improvement
🏈R side - What subjective/objective parameters were checked
🏈Bottom - AE related to stent placement
Stents are only indicated in subset of pts
Stents are NOT therapeutic
If improvement post stent - considered to benefit from surgery
🌟🌟But what do we do if pts🌟🌟
dont meet criteria
dont tolerate stent
are not surgical candidates
Dr Majid again has us covered
Stents are NOT therapeutic
If improvement post stent - considered to benefit from surgery
🌟🌟But what do we do if pts🌟🌟
dont meet criteria
dont tolerate stent
are not surgical candidates
Dr Majid again has us covered
Summary Slide @harvardmed way courtesy Dr Majid.
That's all folks ! Anything you would like to add ?
What are your TBM management pearls ? @MegriMohammed @Donicme @Re_innervated @Int_Pulmonology @ChristophHutchi @RobJLentz @MaldonadoFabien @PCubedMD @majidshafiqmd @vanholdenmd
That's all folks ! Anything you would like to add ?
What are your TBM management pearls ? @MegriMohammed @Donicme @Re_innervated @Int_Pulmonology @ChristophHutchi @RobJLentz @MaldonadoFabien @PCubedMD @majidshafiqmd @vanholdenmd
**typo - stents are not curative **
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