A 74-year-old woman with SLE and APS was incidentally found to have diffuse tracheal calcification, highlighting the need for careful airway management and individualized anticoagulation.
Case Report (n=1)
Diffuse tracheal calcification is a rare but important finding in autoimmune diseases that can complicate airway management and requires careful consideration in critically ill patients.
Abstract Introduction Diffuse tracheal calcification is a rare radiographic finding. Although often incidental, its presence carries important implications for airway management in critically ill patients. We describe a patient with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) who exhibited circumferential tracheal calcification. Case Presentation A 74-year-old woman with SLE and a history of deep venous thrombosis, receiving chronic warfarin therapy, presented with progressive leg pain, edema, lethargy, and recurrent falls. On admission, laboratory studies revealed severe hyponatremia, anemia, a supratherapeutic INR, and acute right femoral-to-popliteal thrombosis. She was started on intravenous heparin therapy. Computed tomography pulmonary angiography excluded embolism but unexpectedly demonstrated diffuse, circumferential tracheal wall calcification (Figures 1 and 2). During hospitalization, she developed inspiratory wheezing; however, oxygenation remained adequate, and intubation was not required. Her course was complicated by catastrophic intramuscular hemorrhage while on anticoagulation, requiring reversal therapy, blood transfusions, vasopressor support, and ICU admission. Additional complications included new-onset atrial fibrillation requiring rhythm control, delirium, and hospital-acquired cellulitis. APS was confirmed by the presence of lupus anticoagulant and anticardiolipin antibodies. After stabilization, anticoagulation was cautiously resumed with low-molecular-weight heparin, and warfarin was eventually planned. Discussion In autoimmune diseases, the differential diagnoses for tracheal calcification include tracheobronchopathia osteochondroplastica, amyloidosis, and relapsing polychondritis. Recognition is critical because calcified, rigid airways may reduce compliance, distort anatomy, and complicate endotracheal intubation or bronchoscopy, even in the absence of an immediate obstruction. This case underscores the therapeutic tension between thrombosis and bleeding in APS, emphasizing the importance of individualized anticoagulation strategies. Conclusion Recognition of diffuse tracheal calcification can guide safer airway management and reinforces the need for individualized anticoagulation strategies in critical illness settings. Figure 1. Coronal chest computed tomography demonstrating diffuse tracheobronchial calcifications. This abstract is funded by: None
Allaham et al. (2026) conducted a case report in Systemic lupus erythematosus and antiphospholipid syndrome with diffuse tracheal calcification (n=1). Anticoagulation therapy was evaluated. A 74-year-old woman with SLE and APS was incidentally found to have diffuse tracheal calcification, highlighting the need for careful airway management and individualized anticoagulation.