Critical Care: Neoplastic Disorders |

Subglottic Tumor Masquerading as Persistent Wheeze in a COPD Patient FREE TO VIEW

Selma Demir, MD; Audrik Perez, MD; Pavan Gorukanti, MD; Sushilkumar Gupta, MD; Mangalore Amith Shenoy, MD; Amit Agarwal, MD; Pavan Irukulla, MD; Chanaka Seneviratne, MD
Author and Funding Information

Maimonides Medical Center, Brooklyn, NY

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

Chest. 2016;150(4_S):340A. doi:10.1016/j.chest.2016.08.353
Text Size: A A A
Published online

SESSION TITLE: Neoplastic Disorders

SESSION TYPE: Student/Resident Case Report Slide

PRESENTED ON: Monday, October 24, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: Wheezing in a smoker is a very common presentation, with broad differential diagnosis. Although COPD is one of the most common etiologies, relatively rare causes like extrathoracic upper airway obstructions, are also among differential. Primary subglottic carcinomas have low incidence constituting about 1% of laryngeal cancers. Diagnosis is usually delayed due to lack of symptoms in the early stages, owing to location of the tumor.1

CASE PRESENTATION: 72-year-old former smoker woman presented with shortness of breath, wheezing, cough, and fever. She had a recent ICU admission for COPD exacerbation, and was discharged a few days prior to the current presentation. On exam she was febrile, and had diffuse expiratory wheezing. Laboratory work up was significant for leukocytosis. Chest imaging revealed hyperaeration of lungs. Patient was treated with NIPPV, steroids, antibiotics, and bronchodilators. Dyspnea resolved, but mild expiratory wheezing persisted. On day 12, patient was evaluated for poor food intake, and examination revealed oral thrush that was attributed to inhaled steroids. ENT evaluation was called to assess the extent of thrush in the larynx. Bedside fiberoptic laryngoscopy revealed immobile right vocal fold with narrowed pinpoint airway, owing to large obstructive submucosal laryngeal mass. Emergent awake tracheotomy was performed to protect the airway, with subsequent direct laryngoscopy. Biopsy showed poorly differentiated squamous cell carcinoma. Ultimately, total pharyngo-laryngectomy was performed. Patient was deemed to have T4aN2bM0 subglottic squamous cell carcinoma.

DISCUSSION: Subglottic tumor is an uncommon clinical entity, with several case reports in the literature via undulant presentations.2 Our patient’s initial presentation of fever and respiratory distress was consistent with COPD exacerbation. She also had a known history of COPD, which was masking the symptoms, and laryngeal carcinoma was not suspected until she was evaluated for the extent of oral thrush.

CONCLUSIONS: Anchoring bias can be a common pitfall while treating a presentation that can be explained by preexisting diagnosis. Suboptimal response to initial treatment should raise suspicion for an alternative diagnosis in a patient with wheeze.

Reference #1: Bahar G, Nageris BI, Spitzer T, Popovtzer A, Mharshak G, Feinmesser R. Subglottic carcinoma. Harefuah. 2002 Oct;141(10):914-8, 929.

Reference #2: Chang C, Chenchao S, Lei D, Yuping L. Pleomorphic adenoma of the subglottis mistreated as chronic obstructive pulmonary disease, report of a case. Ann Thorac Cardiovasc Surg. 2011;17(3):283-6

DISCLOSURE: The following authors have nothing to disclose: Selma Demir, Audrik Perez, Pavan Gorukanti, Sushilkumar Gupta, Mangalore Amith Shenoy, Amit Agarwal, Pavan Irukulla, Chanaka Seneviratne

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543