A 63-year old man presented to an outside hospital's emergency department (ED) with dyspnea. While in the ED he went into a pulseless electrical activity arrest, underwent 1 round of cardiopulmonary resuscitation and was intubated before the return of spontaneous circulation. The intubation was noted to be difficult because of “redundant tissue in the oropharynx.” Providers successfully placed a 6-0 endotracheal tube after failed attempts with an 8-0 endotracheal tube and bougie. The patient was treated for a presumed congestive heart failure exacerbation and multilobar pneumonia and was extubated on hospital day 1. He was noted to have marked dysphagia and dysphonia at that time. A computed tomography scan of the neck was obtained and revealed what were presumed to be 2 surgical clips in the subglottic space and at the level of the epiglottis (Figure 1, Figure 2). Asymmetry of the false vocal cords was seen and thought to be caused by scar tissue.
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Published online: April 30, 2020
Accepted: March 23, 2020
Received in revised form: March 22, 2020
Received: December 14, 2019
Reprints are not available from the authors.
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