Life-threatening tracheal leiomyoma presenting as acute respiratory failure masquerading as refractory asthma: A case report.

Primary tracheal tumors represent less than 1% of all pulmonary neoplasms, with endobronchial leiomyomas accounting for a minute fraction of benign airway lesions. Due to their slow growth and nonspecific clinical presentation, these tumors are frequently misdiagnosed as obstructive airway diseases, such as asthma. We report the case of a 27-year-old female with a 3-year history of progressive, treatment-resistant respiratory symptoms initially managed as severe asthma. Despite escalating medical therapy, her condition deteriorated, culminating in an emergency department presentation with fulminant acute respiratory failure. Chest computed tomography and subsequent rigid bronchoscopy revealed a smooth, well-encapsulated 1.9 cm pedunculated tracheal mass originating from the posterior membranous wall, causing 100% luminal obstruction. The tumor was successfully resected via bronchoscopic snare electrocautery and basket extraction, followed by argon plasma coagulation of the base. Histopathological and immunohistochemical evaluation confirmed a benign tracheal leiomyoma. Postoperatively, the patient experienced immediate, complete resolution of respiratory symptoms with no recurrence at her 3-month follow-up. Tracheal leiomyoma, though rare, can cause life-threatening central airway obstruction where timely imaging and bronchoscopic intervention are ultimately lifesaving.