Tracheal agenesis as a rare cause of difficult intubation in a newborn with respiratory distress: a case report

Abstract

Introduction: Tracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life.

Case presentation: We report a newborn Malay baby boy with trachea agenesis (type III by Floyd's classification) who presented with severe respiratory distress immediately after birth. Clinical diagnosis in this case was not straightforward, as it started with difficulty in intubation followed by an unsuccessful emergency tracheostomy in the neonatal intensive care unit. Urgent surgical neck exploration with endoscopic examination in the general operating theatre revealed the final diagnosis. The authors present a short description of the embryopathology and diagnostic criteria of the abnormality.

Conclusion: We hope this case presentation will be valuable in increasing the awareness of physicians about this rare cause of tracheal obstruction or difficult intubation.

Figure 1

Neck exploration revealed a normal larynx that ended in a blind pouch at the level of cricoid (black arrow). The dome-shaped cricoid occludes the lumen.

Figure 2

Laryngoscopy examination revealed a cleft larynx with immobile vocal cords bilaterally in midline position.

Figure 3

Esophagoscopy view showing one of the openings into the left bronchus at the distal end of the esophagus.