'Nocturnal noises': an isolated stridor in an adolescent

BMJ Case Reports
K I Zalewska, G F A Benfield

Abstract

An 18-year-old man presented to primary care with a 2-year history of exclusively nocturnal 'noisy breathing'. He was otherwise asymptomatic. He had never smoked and was previously healthy. Spirometry showed a severely obstructive picture with forced expiratory volume in 1 s (FEV1) 1.87 L (44% predicted), forced vital capacity (FVC) 4.0 L (80%) and FEV1/FVC ratio of 47%. A diagnosis of asthma was suspected and a trial of inhaled bronchodilators and corticosteroids was initiated. Failure to improve symptoms led to referral to the Respiratory Clinic, where his mother replayed a recording of the 'noisy breathing' on her mobile phone. Subsequent examination revealed a stridor on expiration. Flow volume loop showed a plateau of the expiratory limb, consistent with intrathoracic upper airway obstruction. CT of the thorax revealed a massively dilated oesophagus, filled with food residue, reflecting an achalasia, causing lower tracheal compression. He is now being considered for a myotomy procedure.

References

Feb 12, 1998·European Journal of Gastroenterology & Hepatology·S P Dunlop, S P Travis
Sep 13, 2008·Respirology : Official Journal of the Asian Pacific Society of Respirology·Mihir D Wechalekar, Anne M Southcott
Jun 18, 2009·QJM : Monthly Journal of the Association of Physicians·J D ThomasK Latief
Mar 25, 2011·Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)·N Martinón-TorresR Cabanas Gancedo

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Citations

Dec 19, 2015·Pediatric Pulmonology·Karin Yaacoby-BianuLea Bentur

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