J Md Noor N Abd Karim I Ismail A D Mohd Kamal



Stridor is a potential airway nightmare. Preparation for impending respiratory collapse has to be made emergently. Cricothyroidotomy, which is hailed as the airway rescue in “can’t intubate, can’t oxygenate (CICO)”, can have devastating outcome in certain patient. This case highlight ultrasound as a potential tool in assisting with airway management.


A 56 years old gentleman presented to ED with 3 days history of shortness of breath. He has been having coryzal symptoms for last 4 days and had noisy breathing since that morning. This patient had a history of wound debridement 7 months prior for which he underwent general anaesthesia. Since then he has said that his voice has become hoarse. On examination, his vitals signs were as follow: HR 118/min, BP 139/126mmHg, SpO2 100% under room air. He was tachypnoeic with audible inspiratory stridor. There was no neck swelling, no mass, trachea was central. Provisional diagnosis of vocal cord palsy was made. ENT assessment with flexo nasopharyngolaryngoscope (FNPLS) showed fungating mass involving false vocal cord region extending to subglottic region, irregular mucosa at right vocal cord region. Ultrasound revealed heterogenous mass within the larynx extending from above to below cricoid cartilage. Tracheostomy was performed the next day, followed by CT scan and operation for laryngeal ca.


Ultrasound can act as an adjunct to assessment of stridor. Physical examination alone has its limitation. This patient was fortunate as he did not deteriorate further. Should he desaturate, and physicians found a CICO situation, cricothyroidotomy could potentially be disastrous. 


Supplementary Issue