Tonsillar lipoma causing difficult intubation: a case report.

A 63-year-old woman with confusion and disorientation was referred to the Pulmonary Medicine Department of Afyon Kocatepe University. She was uncooperative and her peripheral oxygen saturation was 75%. She was on diuretic therapy for heart failure. An emergency intubation was planned due to the development of respiratory acidosis and hypoxemia, but the patient could not be intubated. After several attempts, intubation was successful only by digital manipulation of a lateral pharyngeal mass noticed incidentally. She was inadvertently extubated on the third day of intubation and an emergency tracheotomy was performed. Otolaryngological examination revealed a mass originating from the right palatine tonsil, and a computed tomography scan showed a hypodense mass extending from the uvula to the epiglottis. Under general anesthesia, the patient underwent a right tonsillectomy and a lipomatous mass (3.6x3.2x2.2 cm) and the palatine tonsil (3.5x1.1x0.8 cm) were resected. Microscopically, the tumor consisted of mature adipocytes with thin fibrous septae. It should be borne in mind that patients may be unaware of a tonsillar mass that may lead to serious dyspnea and difficult intubation.