C52-46 Bronchoscopy Challenges in a Relapsing Polychondritis Patient With a T-tube: A Case Report

Abstract Introduction Relapsing polychondritis (RP) is a rare, potentially life-threatening, autoimmune disease affecting cartilaginous structures throughout the body. Involvement of the respiratory tract can result in airway collapse or stenosis which is challenging complication. We report a challenging case of RP with previous airway stenting admitted with respiratory failure. Case A 46-year-old female with history of RP on chronic immunosuppression and a tracheal T-tube presented to the emergency department severely hypoxic with chest pain and progressive shortness of breath. A computed tomography scan of the chest revealed diffuse bilateral ground glass opacities, consolidation in the lower lobes, and two thick-walled left upper lobe cavitary lesions. Prior to undergoing bronchoscopy, a multidisciplinary discussion was held between ENT, pulmonology, and anesthesiology due to concerns of airway safety during bronchoscopy with tracheal T-tube in place. Bronchoscopy was completed without complications, but she subsequently removed her T-tube on accident and was transferred for replacement. Discussion This case highlights the challenge of airway management in patients with tracheal T-tubes undergoing endobronchial procedures such as bronchoscopy. Options considered in our case included attempting bronchoscopy directly through the T-tube, placing a laryngeal mask airway through which bronchoscopy would be done, or performing a trans-oral/trans-nasal bronchoscopy while ventilating the patient through the anterior limb of the T-tube. Alternatively, we explored the possibility of replacing the T-tube with a tracheostomy tube or endotracheal tube. However, this would have been risky if the patient’s tracheal stenosis was severe enough to prevent successful tracheal intubation. Through interdisciplinary discussions and shared decision making with the patient, bronchoscopy was ultimately performed through a LMA with T-tube in place without any complication. T-tubes are useful treatment options for RP patients, but they can pose clinical challenges that necessitate interdisciplinary coordination and consideration of different management options for optimal patient outcome. This abstract is funded by: None