title: 'Nocturnal noises': an isolated stridor in an adolescent.
abstract: An 18-year-old man presented to primary care with a 2-year history of exclusively nocturnal 'noisy breathing'. He was otherwise asymptomatic. He had never smoked and was previously healthy. Spirometry showed a severely obstructive picture with forced expiratory volume in 1 s (FEV1) 1.87 L (44% predicted), forced vital capacity (FVC) 4.0 L (80%) and FEV1/FVC ratio of 47%. A diagnosis of asthma was suspected and a trial of inhaled bronchodilators and corticosteroids was initiated. Failure to improve symptoms led to referral to the Respiratory Clinic, where his mother replayed a recording of the 'noisy breathing' on her mobile phone. Subsequent examination revealed a stridor on expiration. Flow volume loop showed a plateau of the expiratory limb, consistent with intrathoracic upper airway obstruction. CT of the thorax revealed a massively dilated oesophagus, filled with food residue, reflecting an achalasia, causing lower tracheal compression. He is now being considered for a myotomy procedure.
authors.affiliation: Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK Cardiff University, Rhondda Cynon Taf, UK.
authors.forename: K I
authors.initials: KI
authors.lastname: Zalewska
authors.affiliation: Department of Respiratory Medicine, Ysbyty Gwynedd, Bangor, Gwynedd, UK.
authors.forename: G F A
authors.initials: GF
authors.lastname: Benfield
mesh_terms: D000293:Adolescent; D004931:Esophageal Achalasia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D045853:Exhalation; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology*; D014797:Vital Capacity