Tracheal agenesis diagnosed by supraglottic airway-assisted endoscopic evaluation during neonatal resuscitation: a case report

Abstract

Background: Tracheal agenesis is an exceptionally rare and typically lethal congenital airway anomaly presenting with failed intubation. We report a case of unrecognized tracheal agenesis in which supraglottic airway-assisted ventilation enabled concurrent fiberoptic endoscopic evaluation during neonatal resuscitation.

Case presentation: A preterm male neonate born at 31 weeks and 1 day of gestation with polyhydramnios and suspected duodenal atresia developed severe respiratory failure immediately after delivery. Repeated attempts at tracheal intubation were unsuccessful despite vocal cord–like structures being seen. Placement of a size 0.5 supraglottic airway (Air-Q^®) resulted in transient partial ventilation with intermittent colorimetric carbon dioxide detection, permitting fiberoptic endoscopic evaluation. Endoscopy demonstrated a blind-ending subglottic pouch and a distal tracheoesophageal fistula, strongly suggesting tracheal agenesis; computed tomography subsequently confirmed the diagnosis of Floyd type II tracheal agenesis.

Conclusions: Early supraglottic airway-assisted endoscopic evaluation may facilitate rapid recognition of tracheal agenesis during neonatal resuscitation and support timely, multidisciplinary decision-making after failed intubation.

Supplementary Information: The online version contains supplementary material available at 10.1186/s40981-026-00852-w.

Keywords: Fiberoptic bronchoscopy; Neonatal airway management; Supraglottic airway; Tracheal agenesis; Tracheoesophageal fistula.

Fig. 1

༎Bronchoscopic findings through the supraglottic airway (Left: glottis-like structure; Right: blind-ending subglottic pouch)

Fig. 2

༎Dilated esophagus and tracheoesophageal fistula (arrow)

Fig. 3

༎ Neck and chest computed tomography. A Axial neck computed tomography at the level indicated by line A on the sagittal view C. The black arrow indicates the blind-ending upper airway subglottic pouch. B Axial neck computed tomography at the level indicated by line B on the sagittal view (C), demonstrating absence of a patent tracheal lumen. C Sagittal cervicothoracic computed tomography. The black arrow shows the supraglottic airway in situ; the white arrow indicates a large volume of free intraperitoneal air. D Coronal cervicothoracic computed tomography demonstrating bilateral main bronchi (black arrows) and markedly dilated esophagus (white arrow), consistent with gas insufflation