{"id":10632,"date":"2025-10-13T07:23:45","date_gmt":"2025-10-13T07:23:45","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=10632"},"modified":"2025-10-14T05:38:43","modified_gmt":"2025-10-14T05:38:43","slug":"post-intubation-subglottic-stenosis-a-case-report-and-review-of-literature","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-october-2025\/post-intubation-subglottic-stenosis-a-case-report-and-review-of-literature\/","title":{"rendered":"Post-Intubation Subglottic Stenosis: A Case Report and Review of Literature"},"content":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text]<\/p>\n

Abstract<\/h2>\n

Tracheal stenosis is a rare but potentially life-threatening condition that may develop following prolonged or traumatic endotracheal intubation. We present a case of a 34-year-old male who developed progressive respiratory distress due to subglottic stenosis one month after an episode of status epilepticus requiring intubation. This case highlights the importance of early recognition, appropriate post-intubation care, and timely intervention in preventing and managing airway stenosis.<\/p>\n

Case Report<\/h2>\n

A 34-year-old male presented to the Emergency Department with complaints of progressive shortness of breath (NYHA Class II\u2013III) for the past three days, worsened on exertion, and associated with a dry cough. He had been evaluated at an outside clinic two days earlier and was treated symptomatically for a lower respiratory tract infection with nebulization, without significant relief.<\/p>\n

No H\/o LOC\/Giddiness\/ Chest pain \/ palpitation\/Fever\/chills & rigor \/ nausea \/ vomiting \/abdominal pain \/ bowel & bladder disturbances<\/p>\n

Past Medical History<\/h3>\n

The patient was a known case of seizure disorder, with a recent hospital admission one month prior (11\/08\/2025) for status epilepticus. He was intubated at an outside hospital and subsequently transferred to our Emergency Department for further management. He was extubated on day 2 of admission, antiepileptic medications were titrated, and he was discharged on 16\/08\/2025.<\/p>\n

Type II Diabetes mellitus<\/p>\n

Examination<\/h2>\n

On arrival, Concious\/oriented\/afebrile
\nAirway (A): Patent, audible wheeze present\/ Stridor +
\nBreathing (B): Bilateral air entry present, B\/L Diffuse wheeze ++
\nCirculation (C): S1, S2 present, no murmurs.
\nDisability (D): GCS 15\/15, moving all four limbs.
\nExposure (E): Temperature 98.6\u00b0F.
\nThroat: No congestion, no tongue swelling, no angioedema<\/p>\n

Investigations<\/h2>\n

A CT Neck and Chest revealed a severe short-segment tracheal narrowing at the C7 level, suggestive of subglottic stenosis.<\/p>\n

\"Post-Intubation<\/figure>\n

Diagnosis<\/h2>\n

Post-intubation subglottic stenosis (PISS).<\/p>\n

Discussion<\/h2>\n

Anatomy and Classification<\/h3>\n

The trachea extends from the subglottic region of the larynx to the carina, bifurcating into the main bronchi.<\/p>\n

Subglottis: Region just above the trachea, below the vocal cords, lacking cartilage rings.<\/p>\n

Glottis: Contains the vocal cords. Supraglottis: Region above the glottis extending to the base of the tongue.<\/p>\n

\"Post-Intubation<\/figure>\n

Stenosis can be categorized as:<\/p>\n

    \n
  1. Laryngeal\/Laryngotracheal stenosis<\/li>\n
  2. Tracheal stenosis<\/li>\n
  3. Tracheobronchial\/Bronchial stenosis<\/li>\n<\/ol>\n

    Clinical Features<\/h3>\n

    Symptoms vary with severity and may include dyspnea, wheeze or stridor, cough, hemoptysis, dysphonia, or dysphagia. Symptoms usually develop 3\u20136 weeks post-extubation in post-intubation tracheal stenosis (PITS).<\/p>\n

    Etiology<\/h3>\n
      \n
    1. Internal (Post-Intubation \/ Post-Tracheostomy): Pressure necrosis from the endotracheal or tracheostomy tube cuff, traumatic or prolonged intubation.<\/li>\n
    2. External: Blunt or penetrating neck trauma, inhalational or chemical injury, foreign body aspiration.<\/li>\n
    3. Inflammatory\/Systemic Causes: Vasculitis (GPA, MPA, RA), SLE, Inflammatory bowel disease.<\/li>\n
    4. Infectious Causes: Mycobacterial (Tuberculosis), Fungal (Aspergillus, Histoplasma), Viral (HSV, CMV, HPV), Bacterial (Staphylococcus aureus, Mycoplasma pneumoniae, Corynebacterium, Haemophilus influenzae).<\/li>\n
    5. Others: Nonmalignant tumors, congenital or idiopathic causes, radiation-induced fibrosis, extrinsic compression.<\/li>\n<\/ol>\n

      Management<\/h3>\n

      Acute management includes nebulized adrenaline and corticosteroid\u2019s to reduce inflammation and edema.<\/p>\n

      Definitive management:<\/p>\n