A Case of Tracheobronchopathia Osteochondroplastica Discovered Accidentally by Difficult Intubation

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  • KONNO Toshihiro
    Department of Anesthesia and Intensive Care Medicine, Akita University Hospital
  • KODAMA Sahoko
    Department of Anesthesia and Intensive Care Medicine, Akita University Hospital
  • KIMURA Tetsu
    Department of Anesthesia and Intensive Care Medicine, Akita University Hospital
  • NIIYAMA Yukitoshi
    Department of Anesthesia and Intensive Care Medicine, Akita University Hospital

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  • 挿管困難を契機に発見された気管気管支骨軟骨形成症

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Abstract

<p>We experienced a case of Tracheobronchopathia Osteochondroplastica（TO）discovered by difficult tracheal intubation during general anesthesia. A 66 year-old woman was diagnosed with acute appendicitis, and underwent emergency surgery under general anesthesia. Mask ventilation was easily performed after induction of anesthesia. Despite Cormack-Lehane grade I with direct laryngoscopy, the end-tracheal tube with an internal diameter（ID）of 7.0 mm could not pass through the glottis because of friction beneath the glottis. After confirming mask ventilation, we re-assessed the airway with computed tomography images. Several protrusions from the anterior part of the tracheal wall seemed to disrupt tracheal intubation. Finally, the trachea was successfully intubated with the thinner tube（ID 6.0 mm）, rotating the bevel toward the posterior wall of the trachea after passing the glottis.</p><p>Because TO often progresses asymptomatically, patients with TO may undergo general anesthesia without a diagnosis. Although TO is one cause of difficult intubation, patients can be managed safely.</p>

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