Difficult intubation due to unknown congenital tracheal stenosis in the adult: a case report and literature review

Abstract

Congenital tracheal stenosis (CTS) is a rare disorder almost always diagnosed in infancy due to respiratory failure and other cardiopulmonary abnormalities. We experienced a 42-year-old female undiagnosed with CTS until difficult intubation upon surgery. Chest X-ray and computed tomography (CT) images revealed bronchial narrowing, which could already be seen prior to intubation, but was left unnoticed. Difficult airway management is a potentially lethal airway emergency. This life-threatening situation is preventable with the appropriate awareness. We report this clinically valuable case for the safety of future patient care. In English and Japanese literature, there are only 12 reported cases of CTS diagnosed in the adult. Ours and six previous cases were discovered with difficult intubation, a preventable life-threatening airway emergency. Pre-intubation images should be examined carefully for the possibility of CTS, as its frequency may be underestimated. Moreover, in treatment resistant recurrent asthmatic episodes, CTS should be kept in mind.

A case of asymptomatic complete tracheal rings in an adult: case report

“…Complete tracheal rings are a rare congenital defect that can cause tracheal stenosis. There are only a few reports of symptomatic adult cases, with many associated with difficult intubation [1,2]. We report a case of a patient with complete tracheal cartilage rings without symptoms or histories of difficult intubation.…”

“…Cases diagnosed in adulthood are extremely rare. There have been only 13 reported cases of complete tracheal rings with tracheal stenosis discovered in adults; of these, seven were found only when intubation failed [2]. Boiselle et al suggested that thoracic CT images can be used to diagnose tracheal rings as concentric narrowing of the trachea with an O-shaped lumen [3]; contrarily, the normal trachea appears C-shaped.…”

“…A case of asymptomatic complete tracheal rings in an adult: case report Tomoko Hayasaka 1* , Takafumi Kobayashi 2 , Yoshida Ako 3 , Yasuhiro Endo 2…”

Asymptomatic tracheal stenosis in a child: An anaesthesiologist’s plight

“…4 Tracheal stenosis may present with symptoms such as dyspnoea, cough, stridor, wheezing or limited exercise tolerance though majority may remain asymptomatic and are diagnosed for first time at the time of endotracheal intubation with possible untoward consequences. 3 We are reporting one such case of asymptomatic tracheal stenosis which resulted in failure of intubation.…”

“…1 Etiology of tracheal stenosis can range from congenital defects such as tracheal webs or tracheomalacia, postintubation injury, trauma, intraluminal tracheal tumor to compression by extraluminal tracheal tumor. 2,3 Subglottic stenosis is considered the third leading cause of congenital stridors in neonates. 4 Most of these cases are selflimited, but some may need intervention that requires a multi-disciplinary approach.…”