Tracheal paraganglioma: a diagnostic dilemma culminating in a complex airway management problem.
A 41-year-old man presented to his general practitioner (GP) with a wheeze and dyspnoea on exercise. Asthma was diagnosed and treatment with inhaled corticosteroid and a beta(2)-agonist commenced. Despite this, his condition deteriorated over three weeks culminating in stridor, requiring emergency admission to hospital. Nasendoscopy revealed a polypoidal lesion in the upper trachea, acting like a ball valve. A local anaesthetic tracheostomy, secured his airway. Subsequent direct laryngoscopy allowed avulsion of the lesion. Alternative methods of airway management are discussed. Histology revealed a paraganglioma. The aetiology of paragangliomas is described and a literature review of tracheal paraganglioma is presented. Post-operative recovery was unremarkable. However, tumour recurrence occurred at nine months. A subsequent revision tracheostomy and laser resection has ensured disease-free survival, one year later. We recommend that acute onset wheeze, refractive to appropriate therapy, should be referred for urgent examination of the upper aerodigestive tract.
Jones
T M
TM
Department of Otolaryngology, University Hospital Aintree, Fazakerley Hospital, Liverpool, UK. terryjones@doctors.org.uk
Alderson
D
D
Sheard
J D
JD
Swift
A C
AC
D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000175:diagnosis; D003937:Diagnosis, Differential; D004630:Emergencies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010236:Paraganglioma, Extra-Adrenal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012135:Respiratory Sounds / Q000209:etiology*; D014134:Tracheal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014139:Tracheostomy