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Bronchomalacia — RACP Paediatrics MCQ

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HardRespiratoryBronchomalaciaRACP Paediatrics

A 6-month-old has persistent wheeze since birth that is present during both inspiration and expiration. The wheeze is worse with feeding and crying but does not change with bronchodilators. Flexible bronchoscopy shows dynamic collapse of the main bronchi during expiration. What is the most likely diagnosis?

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Correct answer: D — Bronchomalacia

Fixed wheeze present from birth that is biphasic, unresponsive to bronchodilators, and shows dynamic airway collapse on bronchoscopy is consistent with bronchomalacia. Tracheomalacia causes predominantly inspiratory stridor, while bronchomalacia causes predominantly expiratory wheeze. Most cases resolve by 2-3 years as cartilage matures.

Reference: RCH Melbourne – 2023 – Chronic Wheeze CPG; RACP Paediatric Curriculum – Respiratory