A Rare Cause of Difficult Intubation.

A 76-year-old, 65-kg, 165-cm man, with coronary artery disease, hypertension, and dyslipidemia, presented for a robot-assisted laparoscopic prostatectomy. After anesthetic induction, the epiglottis and vocal cords were visualized with a video stylet, but multiple nodules were identified when the stylet was passed into the trachea (Fig 1). The anesthesiologist was unable to intubate with 6.0-to-7.5-mm endotracheal tubes. Fiberoptic bronchoscopy revealed relative sparing of the posterior tracheal wall (Fig 2). What is the diagnosis? Fig 2Bronchoscopy showed submucosal nodules arising from the anterior tracheal wall and sparing the posterior wall. View Large Image Figure Viewer Download Hi-res image