Tracheal obstruction presenting as new-onset wheezing.
Two cases of recent-onset dyspnea and wheezing initially treated with bronchodilator therapy for presumed reactive airway disease are presented. Plain-film chest radiographs subsequently demonstrated mediastinal masses causing extrinsic tracheal compression. The first patient had inoperable poorly differentiated squamous cell carcinoma resistant to radiotherapy. The second patient underwent resection of a substernal multinodular goiter with complete resolution of symptoms. The physician should always entertain the diagnosis of upper airway obstruction in all adult patients with new-onset wheezing. New-onset adult wheezing of uncertain etiology should prompt the physician to refer the patient for pulmonary function testing with flow-volume loops.
Fesmire
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Division of Emergency Medicine, University Hospital of Jacksonville/University of Florida College of Medicine.
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D000368:Aged; D000402:Airway Obstruction / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D004630:Emergencies; D005260:Female; D006042:Goiter / Q000150:complications; D006801:Humans; D008479:Mediastinal Neoplasms / Q000150:complications; D012129:Respiratory Function Tests; D012135:Respiratory Sounds / Q000209:etiology*