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Surgical Resection of a Rapidly Enlarging Endotracheal Schwannoma under Veno-Venous Extracorporeal Membrane Oxygenation Support: A Case Report

Year: 2026

Type: article

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.

Source: Surgical Case Reports

DOI: 10.70352/scrj.cr.26-0686