A case of thoracic aortic aneurysm discovered following poor ventilation during induction of anesthesia

Several cases of tracheal stenosis due to thoracic aortic aneurysm have been reported. However, cases of aortic aneurysm discovered following ventilation difficulties immediately after the induction of general anesthesia are rare. The patient, a 90-year-old woman with a history of ascending aortic replacement for a thoracic aortic aneurysm, was scheduled for sternum infection debridement. During induction, adequate ventilation could not be achieved despite the use of positive pressure, even after tracheal intubation. Bronchoscopy showed tracheal compression, which was not apparent in preoperative evaluations. CT imaging on the day demonstrated that the compression was caused by a thoracic aortic aneurysm. A thoracic endovascular aneurysm repair was performed successfully, and the tracheal compression improved afterwards. Compression from outside the trachea should be considered as a potential cause of sudden ventilation difficulties. Particularly in patients with a history of aortic surgery, additional preoperative assessments should be considered.