A 37 year old female presented with C/o cough & breathlessness since six months. CXR shows right lower lobe collapse patient was evaluated and diagnosed as having right endobronchial mass. Planned for surgery of the same.

Patient was evaluated CBC was within normal limits. CXR trachea deviated to Right side with Right collapse of middle and lower lobe. PFT moderate obstruction. CT fibro myoma in Right main Bronchus with collapse of Right middle & Lower lobe. Patient was having regular bronchospasm hence nebulized, bronchodialators and appropriate antibiotics were given. On auscultation Left sided Air entry present and Right sided Air entry diminished in upper zone and middle zone absent in Lower zone. After preop optimization patient was taken up for surgery.

Patient induced and intubated with Left side Mallinckrodt DLT 28F and tube position confirmed by FOB. Surgery commenced and after Pneumonectomy resistance felt and could not ventilate patient was desaturated. FOB done and DLT kinking seen immediately DLT removed and trachea intubated with 7.5IDmm cuffed ETT orally patient in Left lateral position. Meanwhile oxygenation was maintained with 6.5IDm cuffed ETT introduced through Left main bronchus directly by surgeon as instructed by our chief.

Surgery completed well and patient extubated on table.