Bow-shaped tracheal rings: the lesson learnt from an endotracheal intubation.

Tracheal abnormalities are extremely rare and can occur as a single congenital anomaly, as part of a wider spectrum of abnormalities [such as the syndrome of vertebral defects, anal atresia, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal defects (VATER), and the syndrome of vertebral defects, anal atresia, cardiovascular defects, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal and limb defects (VACTERL)] or in tracheomalacia. Congenital complete and near-complete tracheal rings are the more common morphological abnormalities that occur. A case of a long segment of bow-shaped, as opposed to horseshoe-shaped, tracheal rings is presented, along with a review of tracheal anatomy and embryology. This abnormality presented when, during repeated attempts at endotracheal intubation, the anaesthetist was consistently unable to ventilate the patient, whereas they were able to do so with a facemask. Bronchoscopy showed the posterior tracheal wall prolapsing into the airway, and radiology demonstrated this to be due to wide tracheal rings without any intrathoracic abnormality.