Unusual presentation of complete tracheal rings in a 15 year old trauma patient

Complete tracheal rings may be encountered in the spectrum of congenital tracheal stenosis, and is usually diagnosed in early childhood. We present an unusual case of a 15-year-old trauma patient with progressive respiratory failure and an unanticipated difficult airway during intubation. The patient progressed to cardiopulmonary arrest and required extracorporeal membrane oxygenation for respiratory support. Bronchoscopy revealed complete tracheal rings impeding passage of an appropriately sized endotracheal tube into the airway. A much smaller endotracheal tube was required to intubate this patient’s trachea.