Tracheal agenesis: A rare cause of inability to secure the airways in a newborn

Tracheal agenesis – failure of trachea development - is an extremely rare and severe congenital disorder involving the respiratory system and in most cases it is associated with other abnormalities. Three anatomic types of tracheal agenesis were described by Floyd. Antenatal diagnosis is difficult, especially if it is combined with a tracheo-oesophageal fistula. We report a postnatally diagnosed case of a female newborn with Type II tracheal agenesis. Polyhydramnios and right upper limb anomaly were diagnosed prenatally. Only typical postnatal clinical signs, such as severe asphyxia with strong respiratory efforts, no audible cry, failed endotracheal intubation and no palpable tracheal tissue on the neck aroused suspicion of tracheal agenesis. Despite the few published cases when antenatal diagnosis of tracheal agenesis and series of heroic postnatal surgical interventions resulted in few years’ survival, tracheal agenesis is still considered as a lethal condition. Possibilities of antenatal diagnosis, postnatal management and therapeutic options are discussed.