Unexpected difficult intubation due to tracheobronchopathia osteochondroplastica.

Area of Science:

• Medicine
• Pulmonology
• Anesthesiology

Background:

• Tracheobronchopathia osteochondroplastica (TBPO) is a rare condition characterized by calcified nodules in the trachea.
• Airway obstruction due to TBPO can present as a perioperative challenge, complicating procedures like coronary artery bypass grafting.

Purpose of the Study:

• To report a case of difficult endotracheal intubation caused by undiagnosed TBPO.
• To demonstrate the successful management of airway obstruction in TBPO using a self-expandable Nitinol tracheal stent.

Main Methods:

• Computed tomography (CT) and bronchoscopy were used to diagnose tracheal narrowing.
• A Nitinol tracheal stent was inserted to secure the airway for urgent surgery.
• Biopsy confirmed the diagnosis of TBPO.

Main Results:

• Computed tomography revealed multiple calcified nodules along the tracheal wall, confirmed as TBPO by biopsy.
• A Nitinol tracheal stent successfully relieved the airway obstruction, enabling uneventful coronary artery bypass grafting.
• The stent was safely removed on postoperative day 9, with stable respiratory function and no residual symptoms.

Conclusions:

• TBPO is a critical differential diagnosis for unexpected difficult intubation in surgical patients.
• Tracheal stenting offers a viable solution for managing airway compromise in TBPO when tracheotomy is not feasible.
• Nitinol tracheal stents can be safely used and removed, restoring normal respiratory function.