Abstract Introduction Tracheal stenosis (TS) is an upper airway narrowing often resulting from prolonged intubation or tracheostomy, but can be due to autoimmune disorders, trauma, infections, or congenital causes. This case presents an unusual variant, Lambdoid TS (LTS), and emphasizes the need for early recognition and specialized treatment. Case Presentation A 61-year-old male presents for preoperative evaluation prior to a spinal surgery. His medical history includes obesity, COPD, and a motor vehicle accident in 1987 complicated by traumatic brain injury with tracheostomy and prolonged ventilation. Several years later, he had a CT scan for neck pain that revealed possible TS and was referred to Pulmonology for evaluation. PFTs showed fixed obstruction, raising further concern for TS. Bronchoscopy revealed inward angulation of the lateral tracheal walls toward the midline, creating a sharp, inverted “V” shape (resembling the Greek letter lambda, Λ), causing 75% airway occlusion. He was referred to ENT at a tertiary center for specialized treatment, and his surgery was postponed. Discussion TS affects many people; one study reported a prevalence of 32% among 357 mechanically ventilated (MV) and tracheostomized patients with a duration of MV for 7-21 days. CT imaging, often followed by Bronchoscopy, remains the primary method for diagnosing TS. The pathogenesis involves a pressure mismatch between the cuff and capillaries, leading to ischemic changes and fibrosis of the airway mucosa. In LTS, however, the dominant insult is structural collapse of the tracheal cartilage rather than circumferential fibrotic contraction. Therefore, typical treatments such as balloon dilation may offer temporary relief but are often insufficient, as underlying cartilage collapse increases the risk of recurrent airway obstruction. Therapies such as Endoscopic Resection Tracheoplasty or open surgical exploration address airway support loss by removing damaged tissue and restoring structural integrity. This promotes healing and alleviates symptoms. This patient’s ongoing dyspnea is likely due to LTS caused by prolonged ventilation many years ago, combined with his comorbidities. Emphasizing the importance of obtaining a thorough history to explore potential causes and adopting a multidisciplinary approach are essential for prompt diagnosis and treatment. Conclusion This case underscores potential complications of prolonged intubation and tracheostomy, highlighting a rare and distinctive form of airway deformity. Clinicians should maintain a high index of suspicion for post-procedural airway pathology in patients with a history of intubation or tracheostomy who present with unexplained dyspnea. We hope this report contributes to greater awareness and early recognition of such uncommon airway anomalies. This abstract is funded by: none
Qadri et al. (Fri,) studied this question.