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Bow-shaped tracheal rings: the lesson learnt from an endotracheal intubation

A Thaper1, N S Jones

  • 1Department of Otorhinolaryngology, Queens Medical Centre, Nottingham, UK.

The Journal of Laryngology and Otology
|October 29, 2004
PubMed

Insights

Congenital tracheal abnormalities are rare. This case highlights a unique bow-shaped tracheal ring causing difficult endotracheal intubation due to posterior tracheal wall prolapse.

Area of Science:

  • Anatomy and embryology of the trachea
  • Congenital respiratory anomalies
  • Surgical and interventional pulmonology

Background:

  • Tracheal abnormalities are uncommon, presenting as isolated defects or part of syndromes like VATER/VACTERL.
  • Congenital complete and near-complete tracheal rings are the most frequent morphological variations.
  • Tracheomalacia can also be associated with tracheal abnormalities.

Observation:

  • A rare case of a long segment of bow-shaped tracheal rings, distinct from horseshoe-shaped rings, is presented.
  • The abnormality manifested as persistent difficulty with endotracheal intubation, while facemask ventilation was successful.
  • Bronchoscopy revealed posterior tracheal wall prolapse into the airway.

Findings:

  • Radiological imaging confirmed wide tracheal rings as the cause of the prolapse.
  • No associated intrathoracic abnormalities were identified.
  • The unique bow-shaped morphology of the tracheal rings was a key finding.

Implications:

  • This case expands the understanding of congenital tracheal ring morphology and its clinical presentation.
  • Recognizing such anomalies is crucial for successful airway management in affected patients.
  • Further research into the embryological basis of bow-shaped tracheal rings may be warranted.

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