Congenital tracheal stenosis: different clinical pictures for the same disease

<bold>Introduction:</bold> Congenital tracheal stenosis derives from the abnormal development of cartilage tracheal rings. Clinical presentation depends on the degree of stenosis. We present three cases with different onset. <bold>Cases:</bold> 1. Male, 3 months old. Wheezing from birth which increased during crying and mild retractions, misdiagnosed as croup. Airways endoscopy revealed a funnel-shaped tracheal stenosis with a tracheal bronchus confirmed with a chest CT scan. He was treated endoscopically with an endobronchial stent. 2. Female, intubated after birth for severe respiratory distress. At day 5, for failure to extubate, we performed a bronchoscopy that showed a funnel-shaped trachea and no possibility to see the carina with a 2.8 mm scope. The chest CT scan confirmed the long segment stenosis. She was treated with slide tracheoplasty. 3. Male, 2 months old. Increasing stridor from birth. He underwent tidal breathing flow-volume curve compatible with an intrathoracic obstruction and a chest CT scan showing a narrowing of the proximal trachea. The airways endoscopy showed a subglottic stenosis treated with anterior and posterior costal cartilage graft. <bold>Discussion:</bold> Congenital tracheal stenosis presents with variable manifestations correlating with the degree of stenosis. The diagnosis is based on airway endoscopy and CT scan. Different treatments are available according to the type and severity of stenosis, the milder cases may be treated conservatively. <bold>Conclusion:</bold> Congenital tracheal stenosis should always be considered in the differential diagnosis of persistent wheezing, stridor, or respiratory distress. Lung function tests may represent a valid diagnostic tool butshould always be followed by airways endoscopy.