Clavicular Head Subluxation Resulting in Tracheal Compromise in an Osteogenesis Imperfecta Type III Patient: A Case Report

TL;DR

A patient with osteogenesis imperfecta type III experienced tracheal compression due to clavicular head subluxation during anesthesia, a previously unreported complication.

Contribution

This is the first reported case of tracheal compromise in OI type III caused by clavicular head subluxation.

Findings

Tracheal compression and airway obstruction occurred during anesthesia induction in an OI type III patient.

Clavicular head subluxation was identified as the cause of tracheal narrowing via bronchoscopy and CT angiogram.

Abstract

Osteogenesis imperfecta (OI) poses many known challenges to anesthesiologists; however, structural and functional abnormalities of the trachea have not previously been described. OI results in fragile and brittle bones due to a defect in type 1 collagen production. Perioperative anesthetic considerations include risk of fracture with patient positioning, potential for difficult airway, and managing restrictive lung disease in conjunction with spinal deformities. Our case describes an adolescent male patient with OI type III who was found to have significant tracheal compromise and airway obstruction with the induction of general anesthesia for spinal fusion. Bronchoscopy performed after intubation revealed a compression and tortuosity of the distal trachea, confirmed with a postoperative computed tomography angiogram. Subluxation of the right clavicular head caused tracheal compression and narrowing. This is the first reported case of a patient with OI type III with undiagnosed tracheal compression and deviation secondary to clavicular head subluxation.

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