A 36-YEAR-OLD WOMAN with diabetes presented with an acute worsening of progressive dyspnea on exertion that had required multiple visits to a local emergency department over the prior month. Her primary care physician had treated her with increasing doses of asthma medications, which had failed to relieve her symptoms. Her medical history was significant for an episode of bacterial meningitis 2 months earlier, for which she had undergone 4 days of intubation and mechanical ventilation. On admission, she had a weak, breathy voice and biphasic stridor that was worse with talking and exertion, and arterial blood gas analysis revealed that her oxygen saturations were 95% on room air, with a CO2 of 59 mm Hg. A lateral airway film was inconclusive. Flexible nasopharyngoscopy revealed a subglottic soft tissue obstruction. An urgent tracheostomy was performed while the patient was fully conscious. Views of the glottis and subglottis as seen on direct laryngoscopy are shown in Figure 1 and Figure 2, respectively. A sagittal reformat of a 3-mm axial computed tomographic scan of the neck obtained after the tracheostomy is shown in Figure 3; a 7.0-mm endotracheal tube is in place in the trachea.
Le TT, Hardeman SH, Kokoska MS. Radiology Quiz Case. Arch Otolaryngol Head Neck Surg. 2002;128(2):197. doi:10.1001/archotol.128.2.197