Tracheal paraganglioma: a diagnostic dilemma culminating in a complex airway management problem

A 41-year-old man presented to his general practitioner (GP) with a wheeze and dyspnoea on exercise. Asthma was diagnosed and treatment with inhaled c orticosteroid and a beta(2)-agonist commenced. Despite this, his condition deteriorated over three weeks culminating in stridor, requiring emergency a dmission to hospital. Nasendoscopy revealed a polypoidal lesion in the upper trachea, acting like a ball valve. A local anaesthetic tracheostomy, secured his airway. Subseq uent direct laryngoscopy allowed avulsion of the lesion. Alternative method s of airway management are discussed. Histology revealed a paraganglioma. T he aetiology of paragangliomas is described and a literature review of trac heal paraganglioma is presented. Post-operative recovery was unremarkable. However, tumour recurrence occurr ed at nine months. A subsequent revision tracheostomy and laser resection h as ensured disease-free survival, one year later. We recommend that acute onset wheeze, refractive to appropriate therapy, sh ould be referred for urgent examination of the upper aerodigestive tract.