Presentation
This patient went to the OR for a kidney stone procedure and when induced quickly desaturated. Bagging did not work well and the patient was given an emergency tracheostomy by urology.
Patient Data

A soft tissue mass to the right of the trachea in the superior mediastnum. The airway is distorted and a little narrowed. Note how the upper border of this mass is not visible, suggesting it is in the anterior aspect of the superior mediastinum (we knew that anyway, since it is distorting the trachea). This is known as the cervicothoracic sign.




Retrosternal goiter involving Zuckerkandl's tubercle distorting and narrowing the trachea. A tracheostomy has been inserted.
Case Discussion
This case highlights the importance of properly reviewing pre-operative chest x-rays for potential anesthetic difficulties.