Abstract Introduction Primary tracheal tumors are exceedingly rare, accounting for less than 0.1% of all respiratory tract malignancies. Because their symptoms—such as cough, hemoptysis, and hoarseness—are nonspecific, diagnosis is often delayed or mistaken for chronic bronchitis or tuberculosis. We report a case of metabolically active tracheal wall thickening detected on PET-CT in a patient presenting with persistent hemoptysis and hoarseness. Case Presentation A 55-year-old male, chronic tobacco chewer, presented with a two-month history of intermittent hemoptysis, persistent cough, and recent onset hoarseness of voice. There was no fever, weight loss, or constitutional symptoms. Viral markers were negative and INR was within normal limits. Contrast-enhanced CT of the chest revealed diffuse, irregular tracheal wall thickening predominantly involving the anterior and left lateral walls, extending for approximately 5 cm (D1-D3 vertebral levels), with mild luminal compromise and sparing of the posterior wall. The main bronchi were normal. 18F-FDG PET-CT demonstrated metabolically active tracheal wall thickening (maximum SUV 5.0), confirming the lesion’s metabolic activity and suggesting a neoplastic or inflammatory etiology. No cervical lymphadenopathy, pulmonary nodules, or distant metastases were identified. The patient was referred for diagnostic bronchoscopy and tissue biopsy to confirm histopathology, with plans for multidisciplinary management involving pulmonology, head and neck surgery, and oncology teams. Discussion This case highlights the diagnostic challenge of isolated tracheal lesions. Differential diagnoses include squamous cell carcinoma, adenoid cystic carcinoma, tracheobronchial amyloidosis, and granulomatous inflammation. In this patient, the presence of focal FDG uptake and a history of chronic tobacco use favored a malignant etiology. PET-CT served as a critical tool for delineating lesion extent, metabolic characterization, and exclusion of metastases—thereby aiding clinical decision-making and surgical planning. Conclusion Metabolically active tracheal wall lesions, though rare, must be considered in patients with unexplained hemoptysis and voice changes, particularly among tobacco users. Early PET-CT evaluation combined with bronchoscopic biopsy is essential for accurate diagnosis and timely intervention. This case underscores the importance of a multidisciplinary approach in managing uncommon airway pathologies. This abstract is funded by: None
Aziz et al. (Fri,) studied this question.