A Case Report on a Life-Threatening Occult Supraglottic Granulating Mass Masquerading as Life-Threatening Asthma and Presenting as Cardiac Arrest

Structural upper-airway lesions are uncommon but important mimics of asthma.A 74-year-old man with asthma and multiple recent admissions for presumed exacerbations presented with acute dyspnoea and subsequently sustained a pulseless electrical activity (PEA) cardiac arrest.Return of spontaneous circulation was achieved after five minutes, followed by emergency intubation and admission to intensive care.He was diagnosed and treated for presumed acute severe asthma and respiratory infection.By the following day, there was no significant wheeze or bronchospasm and extubation was attempted.He immediately developed severe stridor and profound hypoxaemia, with oxygen saturation falling to approximately 60%.Emergency video laryngoscopy revealed a large mobile supraglottic mass causing apparent "ball-valve" obstruction.Re-intubation restored oxygen saturation to 100%.The lesion was subsequently completely excised by the otorhinolaryngology team, with histopathology demonstrating granulation tissue.This case highlights the importance of considering structural upper-airway pathology when presumed asthma follows an atypical course, particularly when post-extubation stridor persists despite resolution of bronchospasm.