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Tracheal compression by brachiocephalic arterial trunk: a rare cause of failed endotracheal intubation
  1. Rafaela Noversa,
  2. Isabel Gouveia and
  3. Carla Pinto
  1. Anesthesiology, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
  1. Correspondence to Dr Rafaela Noversa; noversarafaela{at}


Encountering and managing an unanticipated difficult airway are among the many challenges faced by anaesthesiologists. Due to the intimate anatomical relationship between the thoracic vasculature and the trachea, an anatomical variation could potentially lead to airway compression. This clinical case report documents a failed intubation in an adult patient caused by undiagnosed extrinsic tracheal compression from the brachiocephalic arterial trunk, a rare condition. After a thorough investigation and diagnostic clarification, a safe anaesthetic plan following the predictable difficult airway guidelines was established to enable surgery. Anaesthesiologists should consider rare vascular causes as potential contributors to difficult airway scenarios, thereby enhancing their expertise.

  • Anaesthesia
  • Medical management

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—RN, IG and CP. The following authors gave final approval of the manuscript—RN, IG and CP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.