# Case Report: Emergency management of difficult airway in a thyroid cancer patient with undiagnosed tracheal diverticulum preoperatively and literature review

## TL;DR

A thyroid cancer patient with an undiagnosed tracheal diverticulum faced intubation challenges, resolved using fiberoptic bronchoscopy, highlighting the need for preoperative airway evaluation.

## Contribution

Demonstrates effective transnasal fiberoptic bronchoscope-guided intubation for managing undiagnosed tracheal diverticulum-related airway difficulties.

## Key findings

- Tracheal tube displacement into the diverticulum caused critical intubation failure.
- Fiberoptic bronchoscopy enabled successful tracheal tube placement in the true tracheal cavity.
- Preoperative bronchoscopy is recommended for patients with suspected tracheal diverticulum.

## Abstract

Tracheal diverticulum, a rare chronic airway pathology characterized by cystic outpouchings from the trachea or main bronchi, has scant epidemiological documentation. We present a thyroid cancer case with known airway stenosis but an undiagnosed tracheal diverticulum. Perioperatively, repeated displacement of the endotracheal tube into the undiagnosed diverticulum caused critical intubation failure and complicated tracheostomy. Under fiberoptic bronchoscopic guidance, the tracheal tube was successfully advanced past a right subglottic diverticular orifice into the left tracheal lumen, achieving secure placement in the true tracheal cavity. Our retrospective analysis of published cases further characterizes pathological features. For elective surgery patients with suspected tracheal diverticulum, particularly those with prior cervical surgery or pathology, we strongly advise preoperative bronchoscopy to confirm the defect and develop tailored airway management. This case also demonstrates that transnasal fiberoptic bronchoscope-guided intubation effectively rescues unanticipated difficult airways during tracheal diverticulum-related reintubation.