Spontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation

We report a rare and potentially life-threatening complication related to tracheal intubation in the formation of obstructive tracheal pseudomembrane. In the present case, the pseudomembrane was spontaneously expectorated; this is very unusual and not been reported before. This condition was first misdiagnosed as edema subglottis. Then, computed tomography revealed a stenosis of the middle trachea, but subsequent flexible bronchoscopy was unable to provide additional information regarding its nature. Before attending a rigid bronchoscopy, planned to better define the cause of stenosis, a thick annular membrane was scraped away with a large amount of coughing. After that, the patient's respiratory symptoms completely resolved. Control at 1 and again 3 months later showed no further tracheal stenosis. The diagnosis of obstructive tracheal pseudomembrane should be considered in cases of post-extubation stridor. Flexible bronchoscopic guidance after extubation may allow to diagnose such a complication earlier, but rigid bronchoscopy remains the treatment of choice.