Difficult double-lumen tube placement due to laryngeal web

We present a case of difficult intubation in a patient with a laryngeal web. A 33-year-old male patient presented for open thoracotomy and had a previously undiagnosed laryngeal web, which complicated the placement of a double-lumen tube. A single-lumen tube was placed with the use of a bougie through the narrowed airway. With the subsequent use of an airway exchange catheter a double-lumen tube was positioned. Techniques for managing narrowing of the supraglottic airway are presented and the literature dealing with laryngeal webs is reviewed. In the setting of an unusual airway and thoracic surgery, ventilation via simpler techniques takes precedence over insertion of more complex tubes.