Obstructive subglottic granuloma after removal of a minitracheostomy tube.

A 58-year-old man underwent an uncomplicated left up-per lobectomy for squamous cell carcinoma on November27, 2004. The patient had a history of ischemic heart dis-ease, and his preoperative forced expiratory volume in 1second was 50% of the predicted value. He had failed tostop tobacco smoking before the operation. A mini-tra-cheostomy tube was inserted for prevention of sputumretention immediately after the operation, using theSeldinger technique through the cricothyroid membrane.The postoperative course was uneventful. The tube wasremoved on the 4th postoperative day, and the patient wasdischarged on the 8th postoperative day. Eight weeks af-ter extubation, the patient developed stridor and gradu-ally worsening dyspnea. Twelve weeks after extubation,he was admitted to our hospital because of his severebreathing difficulty. Bronchoscopy showed an obstruc-tive granuloma arising from the anterior wall of the sub-glottic area (Fig. 1). Under local anesthesia, the granu-loma was cored out using a conventional tracheal tube,resulting in removal of most of the granuloma tissue (Fig.2). Twenty milligrams of methylprednisolone acetate waslocally injected via the cricothyroid membrane. Thepatient’s symptoms disappeared immediately after re-moval of the granuloma. Pathological examinationshowed inflammatory granulation without specific find-ings. The patient is asymptomatic without regrowth ofthe granuloma tissue 12 weeks after the treatment.