[Dyspnoea after complication-free tracheostomy]

Area of Science:

• Pulmonology
• Critical Care Medicine
• Otolaryngology

Background:

• A 70-year-old woman with metastatic breast cancer developed progressive vocal cord paresis, necessitating a tracheostomy.
• Following tracheostomy, the patient experienced worsening dyspnea and respiratory distress, unresponsive to cannula maintenance.

Observation:

• Fiberoptic bronchoscopy revealed a black foreign body distal to the tracheal cannula.
• Removal of the cannula led to the expulsion of a large blood clot.
• Subsequent bronchoscopy showed a tracheal wall ulcer at the cannula's prior position.

Findings:

• The patient's symptoms were caused by an intratracheal blood clot, a rare complication of tracheostomy.
• The blood clot likely formed due to irritation and ulceration of the tracheal wall by the cannula.

Implications:

• Intratracheal thrombi can be a cause of obstructive symptoms after tracheostomy.
• Endoscopic evaluation is essential for patients presenting with new obstructive symptoms post-tracheostomy.
• This case highlights the importance of considering uncommon complications in airway management.