Teratocarcinosarcoma (TCS) is a rare, highly aggressive malignant neoplasm composed of epithelial, mesenchymal and neuroectodermal elements, occurring almost exclusively in the sinonasal region. Primary involvement of the tracheobronchial tree or carina has not been previously reported. We describe a 55-year-old male chronic smoker who presented with cough, progressive dyspnea and haemoptysis. Computed tomography revealed a lobulated soft-tissue mass in the distal trachea overhanging the carina, extending into both main bronchi, causing significant airway obstruction. Bronchoscopy demonstrated greater than 80% bilateral luminal occlusion, necessitating urgent endobronchial debulking using rigid bronchoscopy, snare electrocautery, and cryotherapy. Histopathology with immunohistochemistry confirmed teratocarcinosarcoma. Positron emission tomography-computed tomography (PET-CT) showed metabolically active mediastinal and hilar lymph nodes. The patient was treated with chemoradiotherapy. Follow-up bronchoscopy at 6 months showed no recurrence, and the patient remains asymptomatic under surveillance for 4 years. This case represents the first reported carinal presentation of teratocarcinosarcoma, expands the anatomical spectrum of TCS and emphasizes the value of multimodality treatment for sustained disease control.