A spontaneous tracheal rupture is rare and life-threatening.We postulate that long-term steroid administration is an under-reported risk factor.We present a case of an impending spontaneous tracheal rupture in Tools and Templates a 51-year-old female with a significant medical history of systemic lupus erythematosus and interstitial lung disease, and a drug history of chronic steroid intake for 9 months.An impending tracheal rupture was diagnosed by computed tomography, which prompted surgery.A right thoracotomy, followed Shin Guards by a posterior tracheal repair via an intercostal muscle flap, was done, with venovenous extracorporeal membrane oxygenation support throughout the operation.