Giant Artery Aneurysm Crushed the Windpipe Before Surgery Could Begin

A giant aneurysm of the brachiocephalic trunk compressed a patient’s trachea so severely that the airway’s narrowest point on CT measured only 3.99 millimeters in transverse diameter, according to a case report published in BMC Anesthesiology. The aneurysm reached a maximum diameter of approximately 7.7 centimeters, and the compression left the patient short of breath with a pulmonary infection before surgery. The airway was difficult on two fronts at once: anatomically, because the central airway was narrowed, and physiologically, because respiratory function was already compromised.

The report, authored by Xiaoyong Wei, Yubo Gao, Jun Li, Yinghua Gu, Xing Liu, Hongxing Min and Xinli Ni, describes the anesthetic management after multidisciplinary discussion. The team chose rapid sequence induction combined with videolaryngoscopy-assisted intubation, performed under wet-primed cardiopulmonary bypass standby protection, meaning the heart-lung machine was primed and ready to take over circulation and oxygenation if the compressed airway could not be ventilated.

Two episodes of secretion-induced airway obstruction occurred intraoperatively, and the endotracheal tube was exchanged under cardiopulmonary bypass support. After weaning from bypass, tracheal perforation was identified and repaired during the same procedure. The patient recovered well and was discharged uneventfully.

As a single-patient case report, the account documents one team’s management strategy and outcome rather than testing any technique against alternatives, so it cannot establish which airway approach is safest for similar patients. It does, however, provide a concrete example of the multidisciplinary coordination, imaging-based assessment and bypass standby used when a giant aneurysm creates a combined anatomical and physiological difficult airway.

Subject of Research: Anesthetic management of severe tracheal compression caused by a giant brachiocephalic trunk aneurysm

Article Title: Severe tracheal compression caused by a giant brachiocephalic trunk aneurysm with intraoperative tracheal perforations: a combined anatomical and physiological difficult airway case report

Article References: Wei, X., Gao, Y., Li, J., Gu, Y., Liu, X., Min, H., & NI, X. (2026). Severe tracheal compression caused by a giant brachiocephalic trunk aneurysm with intraoperative tracheal perforations: a combined anatomical and physiological difficult airway case report. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04391-w

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04391-w

Keywords: brachiocephalic trunk aneurysm, tracheal compression, difficult airway, videolaryngoscopy, rapid sequence induction, cardiopulmonary bypass, tracheal perforation, airway obstruction, BMC Anesthesiology, case report, Severe, tracheal