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A Case of Intermittent Upper Airway Obstruction: Sudden Recurrent Choking Sensation
Description
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A6757 - A Case of Intermittent Upper Airway Obstruction: Sudden Recurrent Choking Sensation
Author Block: S. Awadallah, Z. Rehman, H. Sarwar; Pulmonary,Critical Care, and Sleep Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, United States.
Introduction:
Vocal fold polyps are benign non-neoplastic lesions thought to occur as a result of vocal abuse, misuse, or overuse. Current treatments include conservative (non surgical) and surgical approaches.
This case demonstrate a rare presentation of pre-existing polyp which got enlarged due to allergic reaction to new inhaler therapy leading to intermittent upper airway obstruction and stridor
Case Description:
A 54-year-old Caucasian female with past medical history of diabetes mellitus and chronic obstructive lung disease presented to emergency department with dyspnea and facial swelling of three days duration. She has been started on new-metered dose inhaler (MDI) Vilanterol/Fluticasone Furoate inhaled, five days prior to presentation. Two days after she started MDI she noticed facial swelling, worsening dyspnea, and sudden chocking sensation when lying flat. She was admitted to the hospital under medicine team and treated with bronchodilators and steroids but symptoms did not resolve and thus pulmonary team was consulted. On exam, she was noted to have intermittent stridor, which worsened when lying flat and randomly resolve when coughing and sitting up. Chest x-ray showed no acute cardiopulmonary disease and blood work was only notable for mild leukocytosis. Computed tomography (CT) of the neck and soft tissues showed completely patent airway with no acute pathology. A laryngologist was consulted and direct laryngoscopy was performed. She was found to have edematous vocal cords with large polyp on the anterior portion of the arytenoid cartilage flopping in and out of the airway leading to intermittent obstruction. The polyp was surgically removed and her symptoms resolved. Pathology examination of polyp showed ulceration, associated inflammation, and reactive atypia with no evidence of dysplasia or malignancy.
Conclusion:
Our case highlights how a benign vocal fold lesion can present with an alarming finding with stridor and dyspnea that may lead to aggressive therapies such as endotracheal intubation. Direct laryngoscopy examination, if available, can be a great tool in diagnosing these pathologies and prevent unnecessary medical interventions.
Author Block: S. Awadallah, Z. Rehman, H. Sarwar; Pulmonary,Critical Care, and Sleep Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, United States.
Introduction:
Vocal fold polyps are benign non-neoplastic lesions thought to occur as a result of vocal abuse, misuse, or overuse. Current treatments include conservative (non surgical) and surgical approaches.
This case demonstrate a rare presentation of pre-existing polyp which got enlarged due to allergic reaction to new inhaler therapy leading to intermittent upper airway obstruction and stridor
Case Description:
A 54-year-old Caucasian female with past medical history of diabetes mellitus and chronic obstructive lung disease presented to emergency department with dyspnea and facial swelling of three days duration. She has been started on new-metered dose inhaler (MDI) Vilanterol/Fluticasone Furoate inhaled, five days prior to presentation. Two days after she started MDI she noticed facial swelling, worsening dyspnea, and sudden chocking sensation when lying flat. She was admitted to the hospital under medicine team and treated with bronchodilators and steroids but symptoms did not resolve and thus pulmonary team was consulted. On exam, she was noted to have intermittent stridor, which worsened when lying flat and randomly resolve when coughing and sitting up. Chest x-ray showed no acute cardiopulmonary disease and blood work was only notable for mild leukocytosis. Computed tomography (CT) of the neck and soft tissues showed completely patent airway with no acute pathology. A laryngologist was consulted and direct laryngoscopy was performed. She was found to have edematous vocal cords with large polyp on the anterior portion of the arytenoid cartilage flopping in and out of the airway leading to intermittent obstruction. The polyp was surgically removed and her symptoms resolved. Pathology examination of polyp showed ulceration, associated inflammation, and reactive atypia with no evidence of dysplasia or malignancy.
Conclusion:
Our case highlights how a benign vocal fold lesion can present with an alarming finding with stridor and dyspnea that may lead to aggressive therapies such as endotracheal intubation. Direct laryngoscopy examination, if available, can be a great tool in diagnosing these pathologies and prevent unnecessary medical interventions.
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