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 +/- odynophagia  Minimal heartburn  Rest Of SR unremarkable

5. 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

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 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 PO2 88 HCO3 22  PFT  CXR & CT

11. 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

12. Hospital Course Rigid Bronchoscopy Tumor extending to segmental level Tumor extending to segmental level Tracheal Stent placed Tracheal Stent placed Bx pending Bx pending

13. Hospital Course  Respiratory distress improved  Pt was discharged  Planned F/U in OPD for Further Rx