SHM Converge Scientific Abstract ePoster Gallery-Angiotensin-Converting Enzyme Inhibitor (Acei) Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

Angiotensin-Converting Enzyme Inhibitor (Acei) Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

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This case report describes a 61-year-old woman who developed severe tracheal stenosis after being emergently intubated for ACE inhibitor-induced angioedema. She later returned to the ED with stridor and worsening exertional shortness of breath, raising concern for recurrent angioedema. Imaging and airway evaluation showed no upper airway obstruction on laryngoscopy, but bronchoscopy revealed severe subglottic/tracheal stenosis with extensive damage to the tracheal rings, likely related to traumatic intubation.<br /><br />She required balloon dilation of the airway and tracheostomy performed under bronchoscopic guidance. After the procedure, her breathing improved and she was able to resume oral intake. Her hospital course was complicated by hyperkalemia, which resolved after stopping TMP-SMX and giving sodium zirconium cyclosilicate. She was discharged with tracheostomy education and later found to have near-total 3–4 cm subglottic/tracheal stenosis, resulting in aphonia and referral for complex airway reconstruction.<br /><br />The report emphasizes that ACE inhibitor-induced angioedema is uncommon but potentially life-threatening, with higher risk in women and African Americans. Because airway edema may require urgent intubation, clinicians must use extreme caution to avoid airway trauma. Although post-intubation tracheal stenosis is a recognized complication, this case highlights that it should be considered when patients with prior angioedema and intubation later present with dyspnea or stridor. Severe stenosis can greatly affect quality of life and may require tracheostomy or surgical repair.

Asset Subtitle

Gifty D. Marfowaa

Meta Tag

Author List Brian W. Quinn, Gifty D. Marfowaa, Parsia Vazirnia

Category Clinical Vignettes

Concept ACE InhibitorInduced Angioedema

Concept Airway Obstruction

Concept Tracheal Stenosis

Concept Post-Intubation Airway Stenosis

Concept Urgent Intervention

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Gifty D. Marfowaa

Track Adult

Keywords

ACE inhibitor-induced angioedema

tracheal stenosis

emergent intubation

stridor

subglottic stenosis

bronchoscopy

tracheostomy

airway trauma

balloon dilation

airway reconstruction

ACE InhibitorInduced Angioedema

Airway Obstruction

Tracheal Stenosis

Post-Intubation Airway Stenosis

Urgent Intervention