Abstract Introduction Post-intubation tracheal stenosis (PITS) is a potentially life-threatening complication of prolonged or traumatic intubation. Circumferential mucosal injury leads to scarring, fibrosis, and airway narrowing. Early recognition and multidisciplinary management, spanning interventional pulmonology and thoracic surgery, are vital to prevent respiratory compromise. Case Report A 22-year-old female with bipolar disorder presented with progressive shortness of breath, hoarseness, and intermittent stridor following a motor vehicle accident that required endotracheal intubation for airway protection. She self-extubated after three days of intubation and subsequently developed worsening dyspnea and stridor unresponsive to corticosteroids and racemic epinephrine. CT imaging of the neck and chest demonstrated a 2-3 cm segment of tracheal stenosis at the thoracic inlet/subglottic region with luminal narrowing to approximately 4-5 mm (Figure 1). Flexible bronchoscopy confirmed a circumferential narrowing one centimeter below the cricoid without intraluminal lesions. Initial management included systemic corticosteroids and nebulized racemic epinephrine with partial relief. On hospital day 5, the patient?underwent bronchoscopic balloon dilation under monitored anesthesia care. The 3.5 cm stenotic segment was dilated from approximately 4 mm to 12 mm, followed by 40 mg intralesional triamcinolone injection. Stridor and voice quality improved temporarily. Because of recurrent obstruction, she underwent definitive tracheal resection with cricotracheal reanastomosis three weeks later. A horizontal neck incision was made, the stenotic segment, one ring below the cricoid, was resected, and end-to-end anastomosis was completed with absorbable sutures. She was extubated postoperatively, weaned to room air, and discharged home on postoperative day 7 in stable condition. Discussion This case underscores the importance of prompt diagnosis and stepwise management of PITS. While endoscopic dilation and steroid injection can provide temporary relief, surgical resection remains the gold standard for long-segment or refractory disease. Early involvement of interventional pulmonology and thoracic surgery is critical for successful outcomes. Preventing traumatic or premature extubation in high-risk patients remains key to reducing incidence. References: 1. Grillo HC. Surgical treatment of postintubation tracheal injuries. J Thorac Cardiovasc Surg. 1979;78(6):860-875. 2. Herrington HC, Weber SM, Andersen PE. Postintubation tracheal stenosis. Laryngoscope. 2006;116(9):1553-1561. 3. D’Andrilli A et al. Long-term results of laryngotracheal resection for benign stenosis. Eur J Cardiothorac Surg. 2016;50(3):429-437. Figure 1: CT soft-tissue neck showing 2-3 cm tracheal narrowing at the thoracic inlet/subglottic region. This abstract is funded by: none
B George (Fri,) studied this question.