Adult long-segment tracheal stenosis attributable to complete tracheal rings masquerading as asthma

Area of Science:

• Pulmonology
• Critical Care Medicine
• Medical Genetics

Background:

• Congenital long-segment tracheal stenosis, particularly from complete tracheal rings, is a rare condition.
• This condition can present in adulthood and may be misdiagnosed as common respiratory ailments like bronchial asthma.
• Complete tracheal rings are a severe congenital anomaly affecting airway patency.

Observation:

• A 21-year-old patient with a history of asthma presented with respiratory failure, pneumonia, and septic shock.
• The patient experienced persistent airway issues, multiple extubation failures, and dependence on mechanical ventilation.
• Initial misdiagnosis as asthma obscured the underlying congenital long-segment tracheal stenosis.

Findings:

• The patient was diagnosed with congenital long-segment tracheal stenosis due to complete tracheal rings, complicated by tracheomalacia.
• A custom-made tracheostomy tube, extending to the carina, was successfully used to manage the patient's persistent infantile trachea.
• This case represents the first reported instance of long-segment pantracheal stenosis presenting in adulthood.

Implications:

• Airway narrowing conditions like tracheal stenosis should be considered in patients with chronic, unresponsive asthma symptoms.
• A custom-made tracheostomy tube can serve as a viable management option for severe tracheal stenosis when surgical intervention is challenging.
• Early and accurate diagnosis of congenital tracheal stenosis is crucial due to its high mortality rate.