Abstract Subglottic granulomas are a well-recognized complication of intubation-related trauma. They typically develop as a late-phase consequence and may manifest with hoarseness, cough, dyspnea, or, in severe cases, airway obstruction. Hemoptysis, however, is a less common and often overlooked presentation. This case report highlights an unusual presentation of subglottic granuloma and underscores the importance of including it in the differential diagnosis when evaluating patients with hemoptysis. A 64-year-old woman with a recent history of intraventricular hemorrhage was admitted to the intensive care unit, where she required external ventricular drain placement. Her hospital course was complicated by prolonged mechanical ventilation, necessitating tracheostomy placement. After one month, she was successfully decannulated. Two months later, the patient developed intermittent episodes of hemoptysis associated with dyspnea. CT imaging demonstrated multifocal tracheal stenosis with focal wall thickening involving both the cervical and thoracic trachea and bilateral basilar ground-glass opacities. Bronchoscopy identified a posterior subglottic granuloma (image 1), the remainder of the airway exam was unremarkable. No active bleeding was identified at the time of the procedure. Given the findings, hemoptysis was attributed to friability of the subglottic granuloma in the setting of chronic aspiration-related irritation. Treatment with omeprazole and doxycycline led to complete symptom resolution within days.The development of post-intubation granulomas is multifactorial, resulting from mucosal injury due to endotracheal tube pressure, disruption of mucociliary clearance, and persistent local inflammation, often compounded by laryngopharyngeal reflux. Although most patients present with symptoms of airway obstruction, this case demonstrates that chronic aspiration and ongoing mucosal irritation can make granulomas fragile and prone to bleeding, leading to hemoptysis. Management of subglottic granulomas generally requires a multimodal approach. First-line therapy often includes proton pump inhibitors, antibiotics, and speech therapy, while more invasive measures such as surgical excision or intralesional steroid injections are reserved for refractory cases. In our patient, conservative treatment with acid suppression and an anti-inflammatory antibiotic resulted in complete resolution of hemoptysis, highlighting the effectiveness of medical management when airway compromise is not severe. This case illustrated an atypical presentation of a common post-intubation complication. Clinicians should maintain a high level of suspicion for subglottic granulomas in patients with a history of airway instrumentation who present with otherwise unexplained hemoptysis. Early recognition can prevent unnecessary delays in diagnosis and allow for targeted therapy. This abstract is funded by: None
Guo et al. (Fri,) studied this question.