Case Report of an Obstructive Endotracheal Mass from a Blood Clot: An Airway Nightmare

Central airway obstruction from a mass is a rare but deadly manifestation of advanced primary lung cancer that can cause considerable challenges during endotracheal intubation, including airway debris or bleeding, ventilation difficulties, and prolonged postintubation hypoxia.

This case report describes a patient presenting with the chief symptom of massive hemoptysis who was difficult to ventilate and oxygenate after an easy intubation. On bedside bronchoscopy, an obstructing mass was found at the carina that was later determined to be caused by a blood clot. Patient course was complicated by tension pneumothoraces, prolonged hypoxia, and cardiopulmonary arrest. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition of an obstructing airway mass can be achieved with bedside fiberoptic bronchoscopy and allow for prompt mobilization of specialty services with rigid bronchoscopy capabilities for mass removal.