Congenital complete absence of tracheal rings with trifurcate carina: Case report of a rare clinical and endoscopic presentation

We describe the case of a child with isolated absence of cartilaginous tracheal rings and a trifurcate carina. At 6 months of age, the patient presented to our multidisciplinary airway clinic with stridor and recurrent severe respiratory infections requiring hospitalization. Radiographs showed airway narrowing. Exam demonstrated biphasic stridor. Flexible fiberoptic laryngoscopy demonstrated only mild laryngomalacia. Operative bronchoscopy demonstrated severe tracheomalacia with absence of any visible tracheal rings and a trifurcate carina. Subsequent CT imaging corroborated these findings and did not demonstrate any other major abnormality. The patient did not require operative intervention and his subsequent course was uncomplicated.