Stridor Case
History 68 y male Caucasian X smoker for 20y (20 pack) Seen In OPD 2/12 History SOB,Dry Cough, Wt loss
History Previously Healthy no exercise limitation SOB at rest,worsen with exertion No orthopnea,PND,CP, LL swelling NO Wheeze, Fever, Night Sweating
History Hoarse voice Dysphagia Solid food +/- odynophagia +/- odynophagia Minimal heartburn Rest Of SR unremarkable
History PMH : NO chronic lung disease -ve DM, HTN, IHD, CVA -ve DM, HTN, IHD, CVA PSH : Gall stone pancreatitis 1999 Rx : Ventolin, Adavir, Losec
History No occupational exposure Originally from Portugal No recent travel, No Pets FH: -ve Upper GI scope ? Mild erosions
Examination STRIDOR Sat 96% RA BP 120/80 RR 22 HR 100 Afebrile RR 22 HR 100 Afebrile No enlarged LN, Neck Mass NO signs of SVC obstruction
Examination Central Trachea Transmitted Stridor No wheeze,diminished breath sounds CVS, CNS, Abd. NAD
Investigation CBC Hb 120 N mcv BUN, Creat, Lytes N AST 65, ALT 55 Billirubin & Albumen N
Investigation ABG PH 7.40 PCO2 39 PO2 88 HCO3 22 PO2 88 HCO3 22 PFT CXR & CT
Hospital Course Flexible Bronchoscopy Lt Vocal cord limited mobility Lt Vocal cord limited mobility Huge mass staring in the subglottic Huge mass staring in the subglottic region & extending to Lt bronchus region & extending to Lt bronchus Bx Poorly Diff. Ca Vs Lymphoma Bx Poorly Diff. Ca Vs Lymphoma
Hospital Course Rigid Bronchoscopy Tumor extending to segmental level Tumor extending to segmental level Tracheal Stent placed Tracheal Stent placed Bx pending Bx pending
Hospital Course Respiratory distress improved Pt was discharged Planned F/U in OPD for Further Rx