Subacute airway obstruction from a tracheal mucosal flap

Area of Science:

• Medicine
• Pulmonology
• Critical Care Medicine

Background:

• Tracheal intubation, while essential, carries risks including post-extubation airway complications.
• Obstructive tracheal lesions can present as stridor and respiratory distress, mimicking other conditions.

Observation:

• A 15-year-old female developed acute respiratory distress and stridor 29 hours after 35 hours of intensive care unit intubation.
• Initial management, including re-intubation, failed to secure a patent airway.

Findings:

• Urgent bronchoscopy revealed an 80% obstructive tracheal mucosal flap in the subglottic region.
• Successful management involved precise fiberoptic bronchoscope-guided placement of an endotracheal tube distal to the flap.

Implications:

• This case highlights a rare but critical cause of post-extubation stridor, emphasizing diagnostic challenges.
• Early recognition and specialized airway management are crucial for favorable outcomes in such life-threatening tracheal lesions.