Unexpected difficult intubation due to tracheobronchopathia osteochondroplastica

During anesthesia induction for urgent coronary artery bypass grafting in a 63-year-old man, endotracheal intubation was unsuccessful. Computed tomography of the neck revealed multiple calcified nodules along the tracheal wall. Bronchoscopy demonstrated whitish submucosal nodules narrowing the airway lumen. Tracheobronchopathia osteochondroplastica (TBPO) was suspected and confirmed by biopsy obtained during the same operative session. Since tracheotomy was deemed unfeasible, a 16×60 mm self-expandable Nitinol tracheal stent covered with polyurethane was inserted by the thoracic surgery team, allowing surgery to proceed uneventfully. This case highlights TBPO as a rare but important cause of unexpected difficult intubation in the perioperative setting. The stent was removed uneventfully on postoperative day 9. Following stent removal, the patient's respiratory function remained stable, with no dyspnea or obstructive symptoms during follow-up.