Tracheobronchomalacia
ICD-10 J39.8 · ICD-11 CA0Y

Tracheobronchomalacia with Descending Aorta Anterior to the Spine: Left Mainstem Bronchus Compression

Clinical Scenario

In this anatomical configuration, the descending aorta lies too far anteriorly relative to the spine. As a result, the mid-portion of the left mainstem bronchus (L2) becomes trapped between the descending aorta and the pulmonary artery, leading to posterior compression and narrowing of the bronchus.

Treatment Approach

Management centres on maximum medical therapy to optimise mucociliary clearance — combining inhaled agents targeting airway secretions, pulmonary hygiene measures, and control of contributing factors. The full structured regimen is available in the complete protocol.

Clinical Goals
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.sempedsurg.2021.151062

If the descending aorta is located too far anteriorly, the mid-portion of the left mainstem bronchus (L2) can be trapped between the descending aorta and pulmonary artery, resulting in narrowing the bronchus.

A descending aorta located anterior to the spine can cause posterior compression on the mid-portion of the left mainstem bronchus.

In our opinion, all patients need to be optimized using medical therapy prior to considering surgical correction if that is an option, at a minimum to control secretions and infections, as well as optimum nutrition and at least two weeks of adequate growth and positive nitrogen balance in order to tolerate the stress of surgery.

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