A case of successful endotracheal intubation using an image intensifier in a 9-year-old boy with tracheal stenosis was reported. After the induction of anesthesia, the trachea was observed by use of mobile surgical X-ray apparatus under artificial ventilation using a face mask. Because the tracheal wall of the stenotic part was smooth and seemed soft, we selected a plain 5.5 mm diameter endotracheal tube and intubated under observation using an image intensifier. We observed the tube pass through the stenotic part of the trachea without difficulty. We consider that endotracheal intubation under image guidance is useful in a patient with tracheal stenosis.