Primary Tracheal Schwannoma Presenting With Acute Airway Compromise: A Rare Cause of Rapidly Progressive Breathlessness.

Schwannoma is a benign neoplasm arising from Schwann cells and commonly affects peripheral nerves in the head and neck region. Primary intratracheal schwannoma is exceedingly rare and may present with nonspecific respiratory symptoms, often leading to diagnostic delay. We report the case of a 21-year-old male patient who presented with a two-month history of cough with expectoration and progressively worsening breathlessness for two weeks. The patient developed acute respiratory distress necessitating emergency tracheostomy. Contrast-enhanced computed tomography demonstrated a well-defined intraluminal tracheal mass causing critical airway narrowing. Bronchoscopic evaluation confirmed a smooth obstructive lesion. Histopathological examination revealed spindle-shaped cells arranged in Antoni A and Antoni B patterns, with strong diffuse S-100 protein positivity on immunohistochemistry, confirming the diagnosis of schwannoma. Primary intratracheal schwannoma, though rare, should be considered in young patients presenting with unexplained and rapidly progressive airway obstruction. Early imaging and bronchoscopic evaluation are crucial for timely diagnosis. Prompt surgical intervention is potentially life-saving in cases presenting with acute airway compromise.