All that wheezes is not asthma: Adult tracheomalacia resulting from innominate artery compression
Journal
Postgraduate Medical Journal
Journal Volume
93
Journal Issue
1095
Pages
54-55
Date Issued
2017
Author(s)
Abstract
An 83-year-old woman with no known systemic disease presented to the emergency department with shortness of breath and audible abnormal breath sounds which she had had for 1 week. She reported that the abnormal breath sounds had been heard intermittently for more than a decade, occurring mostly during forceful expiration, coughing or when she had a common cold. One hour later, respiratory distress with accessory muscle use and paradoxical abdominal movement developed, and she was admitted to the intensive care unit for management of impending respiratory failure. The presumed diagnosis was severe asthma due to bilateral expiratory wheezes detected by the emergency physician. At admission, a follow-up auscultation disclosed an expiratory stridor loudest at the suprasternal notch, with synchronous expiratory wheezes in the bilateral chest. An anteroposterior chest radiograph showed right tracheal compression at the level of the thoracic inlet (figure 1A), and a coronal view of a chest CT scan disclosed a dilated and tortuous innominate artery causing tracheal deviation (figure 1B). Bronchoscopy at the subglottic level showed pulsatile external compression of the right upper trachea, causing nearly total obstruction during forceful cough (figure 2A, B, see online supplementary video). A diagnosis of tracheomalacia secondary to innominate artery compression was established. After admission, non-invasive ventilation was initiated for respiratory support, together with an inhaled bronchodilator and other supportive care. Her respiratory status was stabilised. Non-invasive ventilation was discontinued on day 3 and she was discharged on day 10 without sequelae.
SDGs
Publisher
BMJ Publishing Group
Type
note