Complete expiratory central airway collapse at general anesthesia recovery: a case report

Abstract

Expiratory central airway collapse is a degenerative tracheobronchial disease that is often overlooked because of its nonspecific clinical features. A man was admitted for evaluation of tracheal nodules. Following bronchoscopic biopsy, a significant increase in airway pressure occurred during anesthesia recovery. Laryngospasm was suspected, and tracheal intubation was performed. Bronchoscopy revealed an almost completely collapsed tracheal lumen. A Y-shaped silicone stent was placed using a rigid bronchoscope to support the airway, allowing spontaneous ventilation to resume. A retrospective review of the images suggested a diagnosis of excessive dynamic airway collapse. The silicone stent was removed after 2 weeks because of discomfort, and no subsequent dyspnea was observed. This case highlights that excessive dynamic airway collapse is easily missed. Anesthesiologists must be educated on this condition, maintain a thorough understanding of the patient's state and illness, and have emergency airway equipment readily available to restore ventilation promptly in cases of severe airway collapse.

Keywords: Airway obstruction; airway stenting; bronchoscopy; case report; general anesthesia; hypoxemia.

Figure 1.

Preoperative computed tomography and intraoperative dynamic bronchoscopic images of the central airway. Preoperative transverse sectional computed tomography images of the (a) middle and (d) lower trachea during inspiration. Intraoperative bronchoscopic images of the (b) middle and (e) and lower trachea during inspiration under mechanical ventilation. Intraoperative bronchoscopy showing diffuse granular protrusions on the posterior wall of the (c) middle and (f) lower trachea during expiration under mechanical ventilation.

Figure 2.

Complete tracheal collapse observed via bronchoscopy after endotracheal intubation. (a, b) Collapse near the front of the tracheal tube tip and (c, d) Collapse in the middle trachea.