Delayed pseudomembranous airway obstruction after double-lumen tube intubation for thoracoscopic surgery: a three-patient case series

Delayed postoperative stridor after thoracoscopic surgery is commonly attributed to laryngeal oedema, retained secretions, bronchospasm, or cardiopulmonary complications. Obstructive fibrinous tracheal pseudomembrane (OFTP) is a recognized but infrequently reported cause of fixed airway obstruction after endotracheal intubation. Reports following double-lumen tube (DLT) intubation remain limited. We report three elderly women who developed progressive inspiratory dyspnoea with stridor 2–3 days after thoracoscopic surgery performed under one-lung ventilation with a 35-Fr DLT or video DLT. All patients were extubated after surgery and were initially stable. Endoscopic airway evaluation revealed pseudomembranous lesions involving the subglottic region and upper trachea. Two patients required emergency airway intervention, including one tracheotomy. Endoscopic removal relieved the obstruction in all three patients. Histopathological examination in two patients demonstrated inflammatory pseudomembranous lesions characterized by neutrophilic infiltration or necrotic fibrinous exudate. Delayed post-extubation stridor after thoracoscopic surgery should prompt early endoscopic evaluation for a fixed subglottic or upper-tracheal lesion. Endoscopic mechanical removal of an obstructive pseudomembrane can provide definitive treatment.