A 59 year old male patient with history of endotracheal intubation and mechanical ventilation complained of mild respiratory distress in the immediate post-extubation period which responded to nebulisation and chest physiotherapy. Patient was maintaining a saturation of 98- 100% on room air. Over the period of next 2 days patient's condition worsened with the intensity of respiratory difficulty becoming so severe that the patient was unable to lie down supine and there was need for supplemental oxygen to maintain a saturation of 95%. On examination, patient was having biphasic stridor but no cyanosis.

Bilateral wheezing was noted in both the lung fields. A provisional diagnosis of tracheal stenosis was made. X- ray soft tissue of the neck showed increased soft tissue density below the vocal cords. To further evaluvate the patient, CECT neck was done which showed circumferenfial thickening of trachea in subglottic region(approx 3 cm) and a tubular object (foreign body approx 3 cm) was seen lying in trachea 4.5 cm above the carina. On bronchoscopy slough covered degenerative foreign body of approximately 3cm with pericondritis and narrowing of the trachea was found.

Bilateral vocal cord and subglottic region was normal. Supracarinal tracheal segment of approximately 5 cm was normal. To our surprise foreign body recovered was plastic in nature and it was concluded that it was a portion of the cuff of endotracheal tube.

Conclusion- As, you should send any tissue taken out for biopsy, you should inspect and document any tube taken out from the body for its completeness.