Abstract

This report describes the case of a 21-year-old male that presented in respiratory failure caused by laryngotracheal stenosis (LTS) related to remote endotracheal intubation. The patient sought treatment for respiratory complaints in the weeks prior, and had a poor response to treatment for asthma. Currently, LTS is predominantly seen as a sequela of invasive airway management, and this case highlights the possibility of delayed presentations. Clinical manifestations and methods of diagnosis are described. Preventive measures, temporizing therapy, and definitive treatment are then discussed. With increasing numbers of patients undergoing invasive airway maneuvers, it is increasingly important for providers to recognize this disease. As is shown in this case, the diagnosis of LTS requires a high clinical suspicion in order to achieve a timely diagnosis and decrease morbidity and mortality.

Key Points

* Laryngotracheal stenosis (LTS) is usually found in patients with a history of endotracheal intubation.

* LTS may not be immediately apparent in the post-intubation period; an allowance should be made for delay in onset of symptoms.

* A stepwise approach to diagnosis includes plain films, helical CT scanning, and bronchoscopy.

* Immediate treatment hinges on the provision of a temporary airway, while definitive treatment depends on the anatomic site and extent of stenosis.

* Providers need to be cognizant of this entity and maintain a high clinical suspicion in any patient that has undergone invasive airway management.