A breathless journey: airway management in a pregnant patient with non-Hodgkin lymphoma

Abstract

Airway compromise due to malignancy in pregnancy is rare but presents significant challenges. Physiological changes during pregnancy may further exacerbate airway obstruction from mediastinal masses, complicating management. We report a case requiring early tracheostomy for airway stabilisation and chemotherapy initiation. A 32-year-old at 17 weeks’ gestation presented with non-Hodgkin lymphoma and a large anterior mediastinal mass causing severe airway compression. Multidisciplinary planning prioritised early airway stabilisation to avoid emergent interventions. Awake fibreoptic intubation allowed controlled tracheostomy placement, securing the airway for chemotherapy. Following the third cycle of treatment, the patient showed a good clinical response with significant mass reduction, improved symptoms, and better tolerance of oral intake. Plans were made for elective Caesarean section at 32–34 weeks, with tracheostomy maintained for airway security during delivery. This case underscores the importance of proactive airway management and collaborative planning in pregnancy complicated by mediastinal mass and airway compromise. Early airway stabilisation and multidisciplinary collaboration are critical in managing pregnant patients with compromised airways, thus optimising maternal and foetal outcomes. Future cases with similar risks may benefit from planned airway stabilisation and multidisciplinary collaboration.