Surgical Resection of a Rapidly Enlarging Endotracheal Schwannoma under Veno-Venous Extracorporeal Membrane Oxygenation Support: A Case Report
- 1Department of Surgery, Division of General Thoracic Surgery and Breast and Endocrine Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
- 2Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
Abstract
INTRODUCTION: Primary tracheal schwannoma is an extremely rare benign tumor, and despite its typical slow growth, it can cause life-threatening airway obstruction as it enlarges. We report a case of an endotracheal schwannoma that exhibited rapid enlargement during the preoperative waiting period. The tumor was safely resected with veno-venous extracorporeal membrane oxygenation (V-V ECMO) support because of the risk of complete airway obstruction.
CASE PRESENTATION: A 73-year-old woman presented with hemoptysis. CT revealed a broad-based endotracheal tumor measuring 11 × 9 × 14 mm that was located 30 mm proximal to the carina. Bronchoscopic biopsy suggested benign schwannoma. The patient returned with worsening dyspnea and increased cough 2 weeks later. Follow-up CT showed rapid enlargement of the tumor to 17 × 12 × 21 mm, leaving a residual airway diameter of 4.2 mm. Given the risk of ventilation failure during the induction of general anesthesia, V-V ECMO was established while the patient was awake under local anesthesia. After adequate extracorporeal gas exchange was confirmed, general anesthesia was induced, followed by orotracheal intubation. Through a median sternotomy, the cervical and upper mediastinal trachea was exposed. The tumor-bearing tracheal segment was circumferentially resected, and primary end-to-end anastomosis was performed. The postoperative course was uncomplicated, and the patient remained recurrence-free at 12 months after surgery.
CONCLUSIONS: Although benign tracheal schwannomas are generally slow-growing, rapid enlargement can occur and potentially cause life-threatening airway obstruction. In patients with severe tracheal obstruction, planned establishment of V-V ECMO before induction of general anesthesia may provide an additional margin of safety during airway management and tracheal reconstruction.
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BibTeX
@article{yasuda2026surgical,
title = {{Surgical Resection of a Rapidly Enlarging Endotracheal Schwannoma under Veno-Venous Extracorporeal Membrane Oxygenation Support: A Case Report}},
author = {Ryota Yasuda and Yasuaki Kubouchi and Sachiko Yasuda and Hiroshi Ishii and So Futagoishi and Masaya Yamasaki and Yuji Nozaka and Wakako Fujiwara and Shinji Matsui and Yoshiteru Kidokoro and Yugo Tanaka},
journal = {Surgical Case Reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0686},
url = {https://doi.org/10.70352/scrj.cr.26-0686},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Surgical Resection of a Rapidly Enlarging Endotracheal Schwannoma under Veno-Venous Extracorporeal Membrane Oxygenation Support: A Case Report
AU - Ryota Yasuda
AU - Yasuaki Kubouchi
AU - Sachiko Yasuda
AU - Hiroshi Ishii
AU - So Futagoishi
AU - Masaya Yamasaki
AU - Yuji Nozaka
AU - Wakako Fujiwara
AU - Shinji Matsui
AU - Yoshiteru Kidokoro
AU - Yugo Tanaka
PY - 2026
DA - 2026/10/28
JO - Surgical Case Reports
DO - 10.70352/scrj.cr.26-0686
UR - https://doi.org/10.70352/scrj.cr.26-0686
AB - INTRODUCTION: Primary tracheal schwannoma is an extremely rare benign tumor, and despite its typical slow growth, it can cause life-threatening airway obstruction as it enlarges. We report a case of an endotracheal schwannoma that exhibited rapid enlargement during the preoperative waiting period. The tumor was safely resected with veno-venous extracorporeal membrane oxygenation (V-V ECMO) support because of the risk of complete airway obstruction. CASE PRESENTATION: A 73-year-old woman presented with hemoptysis. CT revealed a broad-based endotracheal tumor measuring 11 × 9 × 14 mm that was located 30 mm proximal to the carina. Bronchoscopic biopsy suggested benign schwannoma. The patient returned with worsening dyspnea and increased cough 2 weeks later. Follow-up CT showed rapid enlargement of the tumor to 17 × 12 × 21 mm, leaving a residual airway diameter of 4.2 mm. Given the risk of ventilation failure during the induction of general anesthesia, V-V ECMO was established while the patient was awake under local anesthesia. After adequate extracorporeal gas exchange was confirmed, general anesthesia was induced, followed by orotracheal intubation. Through a median sternotomy, the cervical and upper mediastinal trachea was exposed. The tumor-bearing tracheal segment was circumferentially resected, and primary end-to-end anastomosis was performed. The postoperative course was uncomplicated, and the patient remained recurrence-free at 12 months after surgery. CONCLUSIONS: Although benign tracheal schwannomas are generally slow-growing, rapid enlargement can occur and potentially cause life-threatening airway obstruction. In patients with severe tracheal obstruction, planned establishment of V-V ECMO before induction of general anesthesia may provide an additional margin of safety during airway management and tracheal reconstruction.
SN - 2198-7793
ER -