Tracheal buckling: A bizarre but normal finding in chest radiograph of a sick preterm infant

Abstract

Lateral deviation or buckling of the tracheal air column just above the thoracic inlet is infrequently observed on frontal chest X-rays of infants and young children. Tracheal buckling can cause unnecessary concern and alarm to neonatal and pediatric intensivists when dealing with critically ill infants. We report a case of preterm female infant, who was born at 25 weeks of gestation and required intubation at birth and surfactant administration. She was extubated to continuous positive airway pressure support at 5 h of life. On day 24 of life, she had increasing respiratory distress and X-ray of the chest was done. The X-ray showed a significant right lateral deviation of the trachea, raising the concern of mediastinal mass effect or right upper lobe collapse to the attending neonatologist. However, the radiologist diagnosed the lateral deviation of the trachea as benign tracheal buckling. The infant was intubated and ventilated. Two weeks later, a postextubation chest X-ray showed normal trachea.

Keywords

• Tracheal air column
• tracheal buckling
• tracheal deviation