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Clinical Problem Solving
March 2015

Tracheal Mass

Author Affiliations
  • 1Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle
  • 2Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. 2015;141(3):291-292. doi:10.1001/jamaoto.2014.3328

A woman in her 50s presented to the emergency department (ER) with a 3-month history of progressive dyspnea with exertion and 6 weeks of gradually worsening stridor. She had been treated empirically for adult-onset asthma with bronchodilators without improvement. Pertinent medical history included cutaneous melanoma of the left shoulder 4 years previously. The lesion was treated with wide excision, axillary lymph node dissection, and systemic interferon. Following treatment, she had undergone annual surveillance with positron emission tomography (PET). Her most recent negative result from a PET scan was 9 months prior to presentation. On physical examination, the patient displayed stable vital signs, with oxygen saturation greater than 95% on room air. She was able to speak in full sentences and did not display any neck or chest retractions with breathing, but she did have audible biphasic stridor. No clinically significant cervical or axial lymphadenopathy was present. Computed tomography, performed in the ER, revealed an intraluminal posterior tracheal wall mass (Figure, A). Awake flexible bronchoscopy performed under local anesthesia alone in the clinic revealed a purple, pedunculated mass that was mobile with respiration and obstructed 90% of the mid-tracheal airway (Figure, B, and Video). The patient underwent urgent endoscopic subtotal resection of the lesion in the operating room with immediate relief of her respiratory symptoms (Figure, C).

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