A case of asymptomatic complete tracheal rings in an adult: case report
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To the Editor,
Complete tracheal rings are a rare congenital defect that can cause tracheal stenosis. There are only a few reports of symptomatic adult cases, with many associated with difficult intubation [1, 2]. We report a case of a patient with complete tracheal cartilage rings without symptoms or histories of difficult intubation.
Complete tracheal rings are usually detected in the neonatal period or infancy as congenital tracheal stenosis, with symptoms of stridor, cyanosis, retractive breathing, or suffocation. Cases diagnosed in adulthood are extremely rare. There have been only 13 reported cases of complete tracheal rings with tracheal stenosis discovered in adults; of these, seven were found only when intubation failed . Boiselle et al. suggested that thoracic CT images can be used to diagnose tracheal rings as concentric narrowing of the trachea with an O-shaped lumen ; contrarily, the normal trachea appears C-shaped.
In our case, although a tracheal tube could not be passed below the vocal cords, intubation had been successful at the previous general anesthesia. The tip of the tracheal tube was probably impinged at a caudad end of the normal trachea which was transition zone to the tracheal rings. To date, there have been no reports of cases of complete tracheal rings without symptoms such as tracheal stenosis and history of difficult intubation. This case suggests that the complete tracheal rings may be hidden even in normal adults for whom there has been no trouble with intubation. Multiplanar reconstruction CT helps to assess difficult intubation.
We are grateful to Prof. Yamauchi for helpful revision. We would like to thank springer nature (https://secure.authorservices.springernature.com) for English language editing.
All authors revising the manuscript critically and assisted in the preparation of the manuscript. All authors read and approved the final manuscript.
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The authors declare that they have no competing interests.
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