Posterior Mediastinal Biopsy Gone Awry: Managing Biopsy Needle-Induced Intubation Challenges in Emergency Surgery

Foreign bodies entering the thorax via a posterior trajectory present distinct challenges in positioning and intubation, particularly during emergency exploration. We present the case of a 37-year-old female who sustained a subclavian artery perforation during a computed tomography-guided biopsy for a posterior mediastinal mass. The biopsy needle advanced to the left common carotid artery. She was brought in the prone position for emergency surgical exploration, which posed significant challenges for airway management. This case highlights the importance of flexible airway strategies, multidisciplinary coordination, and decision-making in managing endotracheal intubation under non-standard conditions.