# Utilization of Preoperative Endoscopic Airway Examination Guiding Difficult Airway Management in an Unknown Cause of Mucositis: A Case Report

## TL;DR

A preoperative endoscopic airway exam helped safely manage a difficult airway in a patient with unexplained mucositis and guided treatment decisions.

## Contribution

Demonstrates the utility of preoperative endoscopic airway examination in managing difficult airways with unknown pathology.

## Key findings

- PEAE revealed no significant airway edema or active bleeding, allowing safe EGD under TIVA.
- The patient was later diagnosed with lymphoma and paraneoplastic pemphigus.
- PEAE provided critical information for airway planning in a complex case.

## Abstract

Assessing the extent of pathology in difficult airways and choosing the optimal airway management strategy in such cases can be a challenge for clinicians. Preoperative endoscopic airway examination (PEAE) is helpful in evaluating a challenging airway and formulating an airway plan in stable patients. A 52-year-old male scheduled for esophagogastroduodenoscopy (EGD) and biopsy presented with dysphagia, aphonia, mucositis, mucosal bleeding, and impaired mouth opening from pain. We were unable to complete the airway exam and were concerned about possible airway edema. PEAE was easily performed in preoperative holding area, airway was significant for erythema with no significant edema, no active bleeding, and mucosa had cobblestone-like appearance. With this information, we were confident to undergo EGD and biopsy with native airway under total intravenous anesthesia (TIVA). The patient was later diagnosed with diffuse large B cell non-Hodgkins lymphoma and paraneoplastic pemphigus.