Critical Airway Obstruction From a Near-Carinal Intratracheal Tumor Managed with Intratracheal Cryotherapy: A Case Report.

Abstract

Background: Intratracheal tumors are rare neoplasms that may pose significant diagnostic and therapeutic challenges because of their critical location within the central airway. Pleomorphic adenoma arising in the trachea is exceedingly rare, with only a limited number of cases reported in the literature.

Case presentation: We report a case of a 45-year-old patient presenting with stridor, dyspnea, and hemoptysis who was found to have a distal intratracheal mass located one to two tracheal rings above the carina. Bronchoscopic biopsy with planned cryotherapy was performed; however, airway management was particularly challenging due to the tumor's location, which made tracheostomy unfeasible and distal endotracheal intubation technically difficult. During cryotherapy, manipulation of the lesion triggered bleeding, bronchospasm, and acute airway collapse, resulting in severe ventilatory compromise that required urgent airway stabilization and selective intubation distal to the tumor. Histopathological examination confirmed pleomorphic adenoma.

Conclusion: This case highlights the unique airway management challenges posed by intratracheal tumors located near the carina and underscores the importance of meticulous pre-procedural planning, anticipation of complications, and readiness for emergency airway interventions during bronchoscopic treatment. Even minimally invasive procedures such as cryotherapy may lead to life-threatening airway compromise when tumors are located in critical central airway regions.