• Alfonso Fiorelli, Giovanni Vicidomini, Gaetana Messina, and Mario Santini.
• Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 2, I-80138 Naples, Italy.
• Eur J Cardiothorac Surg. 2011 Jul 1; 40 (1): 261-3.

AbstractWe report a rare and potentially life-threatening complication related to tracheal intubation in the formation of obstructive tracheal pseudomembrane. In the present case, the pseudomembrane was spontaneously expectorated; this is very unusual and not been reported before. This condition was first misdiagnosed as edema subglottis. Then, computed tomography revealed a stenosis of the middle trachea, but subsequent flexible bronchoscopy was unable to provide additional information regarding its nature. Before attending a rigid bronchoscopy, planned to better define the cause of stenosis, a thick annular membrane was scraped away with a large amount of coughing. After that, the patient's respiratory symptoms completely resolved. Control at 1 and again 3 months later showed no further tracheal stenosis. The diagnosis of obstructive tracheal pseudomembrane should be considered in cases of post-extubation stridor. Flexible bronchoscopic guidance after extubation may allow to diagnose such a complication earlier, but rigid bronchoscopy remains the treatment of choice.Copyright © 2010. Published by Elsevier B.V.

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