Case Report of an Obstructive Endobronchial Mass from a Blood Clot: An Airway Nightmare

Abstract

BackgroundCentral airway obstruction from a mass is a rare but deadly manifestation of advanced primary lung cancer that can cause significant challenges during endotracheal intubation, including airway debris or bleeding, ventilation difficulties, and prolonged post-intubation hypoxia. Case reportThis case report describes a patient presenting with the chief complaint of massive hemoptysis who was difficult to ventilate and oxygenate after an easy intubation. On bedside bronchoscopy, an obstructing mass was found at the carina that was later determined to be caused by a blood clot. Patient course was complicated by tension pneumothoraces, prolonged hypoxia and cardiopulmonary arrest. Why should an emergency physician be aware of thisEarly recognition of an obstructing airway mass can be achieved with bedside fiberoptic bronchoscopy and allow for prompt mobilization of specialty services with rigid bronchoscopy capabilities for mass removal.