Emergency airway management of a relapsing polychondritis patient with tracheal stent migration: a case report

Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by recurrent inflammation of cartilaginous structures, frequently involving the tracheobronchial tree. Progressive airway involvement may result in tracheal stenosis and tracheobronchomalacia, often necessitating airway stent placement. Airway management in these patients is particularly challenging, especially in the presence of stent-related complications such as migration.

A 71-year-old man with RP and a history of tracheobronchial stent placement presented with respiratory distress following a traumatic fall. Emergency tracheal intubation was indicated due to progressive hypoxemia. Computed tomography (CT) revealed cephalad migration of the tracheal stent, resulting in misalignment between the stent lumen and the native airway. Rapid sequence induction was performed under video laryngoscopy. During intubation, significant gastroesophageal regurgitation occurred. A 7.0-mm endotracheal tube was initially positioned with the cuff at the level of the vocal cords to reduce the risk of aspiration. After thorough suctioning of gastric contents, the tube was advanced into the stent lumen under flexible bronchoscopic guidance. Bronchoscopy revealed airway collapse consistent with tracheobronchomalacia and impaired ventilation of the right lung due to stent malposition. Attempts to reposition the stent were unsuccessful. The patient subsequently developed severe pulmonary infection and acute respiratory distress syndrome (ARDS) and died two weeks later.

Emergency airway management in patients with tracheal stents is technically challenging, particularly in the presence of stent migration. Bronchoscopic guidance is essential to ensure proper alignment of the endotracheal tube with the stent lumen. Clinicians should anticipate altered airway anatomy and be prepared for complex airway interventions.