PMC7842837_01
(a) Chest X-ray showing tracheal deviation at the tbl4-T5 level. (b) & (c) Coronal cut contrast- enhanced MDCT showing narrowing at the tbl4-T5 level, along with an enlarged thyroid. (d) 3D Reconstruction of MDCT with virtual endoscopy showing tracheal narrowing. (e) Straw ETT (Tritube) used for the initial intubation. (f) CO2, intratracheal pressure, and tidal volume readings during the procedure.
qmj-2020-048-g001.jpg
PMC7842837_01_qmj-2020-048-g001.jpg
fig1
An early chest X-ray image taken during a primary health center visit 6 months prior to his general surgery clinic showed tracheal deviation (Figure 1, a) due to thyroid swelling. It resulted in significant deviation, rotation, and displacement of the related proximal trachea to the right, reducing its caliber from side to side, averaging a minimum of approximately 4-5 mm (Figure 1, b & c). Significant encroachment upon the trachea, compromising its lumen, irregular walls with no line of cleavage, and possible microscopic/minimal infiltrations due to irregularities were noted on the virtual endoscopy (VE) (Figure 1, d).
(a) shows the carina at the level below the stenosed area of the trachea, while (b) & (c) show the stenosed area in the trachea at the level of tracheal rings 5-6. The figures were obtained from fiber optic tracheoscopy.
qmj-2020-048-g002.jpg
PMC7842837_01_qmj-2020-048-g002.jpg
fig2
The procedure showed a highly vascularized mucosa covering a large mass occupying the left side of the trachea starting from the cricoid region to the level of the 7th tracheal ring (Figure 2, a, b, & c).