Masqueraders of exercise-induced vocal cord dysfunction

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Presentation transcript:

Masqueraders of exercise-induced vocal cord dysfunction Stephen A. Tilles, MD, Andrew F. Inglis, MD Journal of Allergy and Clinical Immunology Volume 124, Issue 2, Pages 377-378.e3 (August 2009) DOI: 10.1016/j.jaci.2009.03.026 Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Left, Laryngoscopy photograph from patient 4 shows membranous stenosis just below the glottis with a small round posterior airway. Middle, Flow volume loop from patient 4 with significantly decreased expiratory and inspiratory flows, suggesting fixed obstruction. This illustrates the importance of examining both the flow volume loop and numeric data before interpreting abnormal findings. FEF50/FIF50, Ratio of forced expiratory flow to forced inspiratory flow at 50% FVC. Right, Spirometry from patient 4 reveals low FEV1, normal forced vital capacity, and low FEV1/ forced vital capacity. Journal of Allergy and Clinical Immunology 2009 124, 377-378.e3DOI: (10.1016/j.jaci.2009.03.026) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Left Laryngoscopy photograph for patient 2 shows obstruction of the glottic opening by abnormal positioning of the right arytenoid. Middle, Truncation of the inspiratory portion of the flow volume loop in patient 2, suggesting extrathoracic obstruction. Right, Patient 2 spirometry findings include an abnormally elevated ratio of forced expiratory to forced inspiratory flow at 50% of forced vital capacity (FEF50/FIF50), suggesting extrathoracic obstruction. Journal of Allergy and Clinical Immunology 2009 124, 377-378.e3DOI: (10.1016/j.jaci.2009.03.026) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Patient 3: bronchoscopy photograph taken from the proximal trachea showing tracheal origin of the right upper lobe bronchus and stenosis of the distal trachea. Journal of Allergy and Clinical Immunology 2009 124, 377-378.e3DOI: (10.1016/j.jaci.2009.03.026) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions