Obstructive Lung Diseases: Obstructive Lung Disease |

Dyspnea and Wheeze Don't Always Indicate Asthma: A Case of Tracheal Stenosis Treated With Rigid Bronchoscopic Tracheal Dilatation FREE TO VIEW

Mara Rubia Lima, MD; Ana Moreira, MD; José Moreira, MD; Jackeline Souza, MD; Camila Zuconi; Gabriela Buffon; José Felicetti, MD; Victoria Lau; Beatriz Mantuan; Guilherme Watte
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UFCSPA, Porto Alegre, Brazil

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A404. doi:10.1016/j.chest.2016.02.419
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SESSION TITLE: Obstructive Lung Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: The incidence of tracheal stenosis decreased with large volume, low pressure endotracheal tube cuffs but it is still a problem for interventional pulmonologists being a serious complication post endotracheal intubation and tracheostomy. Besides dyspnea and wheeze, tracheal stenosis causes inspiratory stridor but this may not suggest the correct diagnosis at initial presentation in 44% of the cases which are often misdiagnosed as asthma.

CASE PRESENTATION: In May 2015, a 19-year-old non-smoker patient was referred to a tertiary hospital with dyspnea on exertion, wheeze, non-productive cough and dizziness, over the past 12 months. She was treated as asthma but symptoms worsened despite of good adherence to treatmente requiring systemic corticosteroid therapy, emergency room visits, and hospital admissions. Clinical examination: stridor, diffuse wheezing, oxygen desaturation to minimum efforts. Denied respiratory symptoms in childhood or previous pulmonary disease. Reported untreated chronic rhinosinusitis. History of intubation followed by tracheostomy during 33 days, in May 2014, after a car accident, that caused ribs and vertebra fractures, kidney and spleen drilling, undergoing splenectomy. Image exams show reduction of tracheal diameter, and bronchoscopy shows narrowing of about 90% of the trachea. She underwent rigid bronchoscopic tracheal dilations with rigid sheaths 6.5; 7.5; 8.5. From the first dilation session, endoscopic evaluation revealed gradual improvement of tracheal stenosis. Patient reports improvement of symptoms and lung functional tests are normal in follow up visit.

DISCUSSION: The diagnosis of a typical asthma is usually easy. We reported a case of asthma starting at 18 with dizziness, stridor, no response to treatment, and past history of intubation and tracheostomy. Atypical clinical pictures need meticulous medical history, physical examination, image exams and bronchoscopy that can identify a tracheal stenosis. Repeated sessions of rigid bronchoscopic dilation are an advance for tracheal stenosis management replacing reconstructive surgery with less risk of complications and morbidity.

CONCLUSIONS: The lesson brought by this case is that postintubation and post tracheostomy tracheal stenosis is a common problem for interventional pulmonologists but is a challenge in a Pulmonology outpatient unit where it needs to be assessed in cases of no response to asthma treatment and atypical clinical manifestations.

Reference #1: Curley FJ. Dyspnea. In: IRWIN RS; CURLEY FJ & GROSSMAN RF, ed. Diagnosis and treatment of symptoms of the respiratory tract. Futura Publishing, Armonk, p. 55-115, 1997

Reference #2: Brichet A, Verkindre C, Dupont J, Carlier ML, Darran J. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J 1999;13:888 -893

Reference #3: FERREIRA, Susana et al. Técnicas de dilatação broncoscópica e aplicação tópica de mitomicina C no tratamento da estenose traqueal pós-entubação-. Rev Port Pneumol [online]. 2010, vol.16, n1

DISCLOSURE: The following authors have nothing to disclose: Mara Rubia Lima, Ana Moreira, José Moreira, Jackeline Souza, Camila Zuconi, Gabriela Buffon, José Felicetti, Victoria Lau, Beatriz Mantuan, Guilherme Watte

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