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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.
Figure 1Computed tomography scan revealing a subglottic foreign body (arrow).
