Patricia W. Maina, MD
Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Daniel Pan, BA
Medical Student
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States
Gary Galang, MD
Physician
UPMC
Pittsburgh, Pennsylvania, United States
Siulam Koo, DO
Fellow Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Posterior glottic stenosis (PGS) and Subglottic Stenosis (SGS)
Case Description:
The first patient was a 59-year-old female with remote tracheostomy (healed) and chronic obstructive pulmonary disease (COPD) without supplemental oxygen who was found to have a traumatic subdural hematoma. She had an uncomplicated intubation with extubation after eight day. Upon admission to inpatient rehabilitation (IPR) two weeks after extubation, she had wheezing and a hoarse voice. Despite discontinuation of propranolol, treatment with supplemental oxygen, and bronchodilators her symptoms worsened and she developed biphasic stridor. Laryngoscopy completed by otolaryngology demonstrated PGS. Ultimately, she underwent airway dilation and steroid injection in the operating room (OR).
The second patient was a 28-year-old female with recent traumatic brain injury and recent aspiration pneumonia treated with steroids and antibiotics who was admitted to IPR 2 months after intubation with extubation fifteen days after. On IPR admission, she had biphasic stridor. CT revealed significant SGS. She underwent airway dilation in the OR by thoracic surgery.
Discussions:
PGS and SGS are life-threatening complications of intubation. PGS is rare in those intubated for less than 10 days, it is often underdiagnosed; with symptoms starting three weeks after extubation and worsening over the following months. SGS typically occurs three to four weeks up to years following intubation. Having two cases of tracheal stenosis first identified in IPR setting rather than during acute care hospitalization, especially with one being PGS, would be a rare occurrence. Tracheal stenosis should be considered among the differential diagnoses in the IPR setting given that patients are now being admitted to IPR more quickly following extubation.
Conclusions:
Through these cases, PGS and SGS in patients presenting for IPR are highlighted. Identifying these diagnoses can be crucial in the rehabilitation process for a patient developing worsening dyspnea during therapy and should not be overlooked given the need for prompt intervention.
