Stridor Case

1
Stridor Case
2
History

• 68 y male Caucasian
• X smoker for 20y (20 pack)
• Seen In OPD
• 2/12 History SOB ,Dry Cough , Wt loss

3
History

• Previously Healthy
• no exercise limitation
• SOB at rest ,worsen with exertion
• No orthopnea ,PND ,CP, LL swelling
• NO Wheeze , Fever , Night Sweating

4
History

• Hoarse voice
• Dysphagia ?Solid food
• /- odynophagia
• Minimal heartburn
• Rest Of SR unremarkable

5
History

• PMH NO chronic lung disease
• -ve DM , HTN , IHD , CVA
• PSH Gall stone pancreatitis 1999
• Rx Ventolin , Adavir , Losec

6
History

• No occupational exposure
• Originally from Portugal
• No recent travel , No Pets
• FH -ve
• Upper GI scope ?? Mild erosions

7
Examination

• STRIDOR
• Sat 96 RA BP 120/80
• RR 22 HR 100 Afebrile
• No enlarged LN , Neck Mass
• NO signs of SVC obstruction

8
Examination

• Central Trachea
• Transmitted Stridor
• No wheeze ,diminished breath sounds
• CVS , CNS, Abd. ? NAD

9
Investigation

• CBC Hb 120 N mcv
• BUN , Creat , Lytes N
• AST 65 , ALT 55
• Billirubin Albumen N

10
Investigation

• ABG PH 7.40 PCO2 39
• PO2 88 HCO3 22
• PFT
• CXR CT

11
Hospital Course

• Flexible Bronchoscopy
• Lt Vocal cord limited mobility
• Huge mass staring in the subglottic
• region extending to Lt bronchus
• Bx? Poorly Diff. Ca Vs Lymphoma

12
Hospital Course

• Rigid Bronchoscopy
• Tumor extending to segmental level
• Tracheal Stent placed
• Bx pending

13
Hospital Course

• Respiratory distress improved
• Pt was discharged
• Planned F/U in OPD for Further Rx